Discussion today regarding reversal of over-anticoagulation with warfarin. Link to recent Annals trial attached - essentially showed that low-dose vitamin K did not improve clinical outcomes in patients with elevated INR due to warfarin overdosage.
http://www.annals.org/content/150/5/293.full
Also - here is the link to the NEJM article on dabigatran. This oral direct thrombin inhibitor was equivalent to warfarin in preventing stroke in patients with atrial fibrillation and resulted in fewer bleeding complications. FDA review is in process, the drug is already available in Europe and Canada.
http://content.nejm.org/cgi/content/short/NEJMoa0905561v1
Finally the Chest supplement on latest warfarin use guidelines is linked below. One item that I did not mention is that recombinant factor VII is an option for reversal. It is quite expensive but may be an option for patients at risk for developing volume overload with FFP infusion. Vitamin K doses of 10mg are only recommended in the setting of significant hemorrhage associated with elevated INR. Intravenous vitamin K should only be considered for immediately life threatening hemorrhage due to the anaphylaxis risk with this mode of infusion.
http://chestjournal.chestpubs.org/content/133/6_suppl/160S.full.pdf
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
Subscribe
Posts
Comments
No comments:
Post a Comment