What to do when warfarin therapy goes too far.

Warfarin is certainly a lifesaver--but it can also lead to potentially fatal hypocoagulability. Here we recommend best reversal options based on the type of bleed. For patients with an elevated international normalized ratio (INR) with mild or no bleeding, withhold the warfarin and recheck INR in 1 to 2 days; if INR >5, add oral vitamin K supplementation. For major bleeding and elevated INR, hospital admission, vitamin K, fresh frozen plasma, and frequent monitoring are needed. Emergent situations call for hospitalization, clotting factor replacement, and vitamin K administered by slow intravenous infusion.