WARFARIN  OD

 

Overview:

  1. Can occur secondary to use for medical purposes, suicide  or poisoning with rat poison

S & S:

  1. Bleeding manifestations such as epistaxis, GI/GU bleed, CVA, patechiae, ecchymosis.

DX:

  1. > PT

Treatment:

  1. IVF, O2
     
  2. Transfuse with FFP and PRBC prn
     
  3. EKG to r/o ischemic changes if bleeding is present
     
  4. Vitamin K 10 mg IV over 10 min. Few problems are associated with Vit. K. It can cause anaphylactoid reaction and profound hypotension. It also causes full anticoagulation reversal that, in patients who have strong need for anticoagulation, such as A. fib or even more so a cardiac valve replacement, it may  take a few days before warfarin  resistance caused by Vit. K  is eliminated and warfarin may be reinstituted. It is suggested that lower doses of Vit. K (0.5-1.0 mg) would decrease the PT with  less interference with reinstitution of warfarin.

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