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Types Of Anticoagulation Reversal

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Evidence Based Practice – Anticoagulation Reversal
Amanda Bensman, Jennifer Davis, Laura Eichenlaub, Ursula Jackson, Brandon Waskey
Ohio University
Evidence-based practice in nursing
NRSE 6120
Dr. Nicholson
5/12/2014

Evidence Based Practice – Anticoagulation Reversal
Introductory Paragraph
Anticoagulation is frequently indicated for a variety of medical conditions and warfarin is the choice drug used to achieve the desired International Normalized Ratio (INR) levels between 2-3 to manage these conditions. Unexpectedly, elevated INR values are commonly encountered in the clinical practice and warfarin reversal is a common clinical situation. In cases of anticoagulation, with the common treatment goal to maintain INR between 2 and 3, the challenge for a physician is to maintain this range over an extended period of time. If a patient’s INR is found to be greater than 5, warfarin is held and the physician may order either fresh frozen plasma (FFP) or vitamin K in order to quickly lower the INR to a safe range (Tuzson, 2009). Depending on the urgency, the types of anticoagulation reversal could vary between using vitamin K, and fresh frozen plasma (FFP), or prothrombin complex concentrates (PCCs), or activated factor VII to decrease the elevated INR to a safe level (Gatt, 2009).
Significance
Oral anticoagulants (OAC) such as coumarin derivatives (e.g. phenprocoumon, acenocoumarol and warfarin) are widely used as long-term medication in the prevention of cerebral infarction, cardiac or arterial thromboembolism, in patients with either valvular or non valvular atrial fibrillation or with mechanical heart valves, for the prophylaxis of deep vein thrombosis in orthopedic surgery, and in the management of the antiphospholipid sy...

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Gatt, A., Riddell, A., van Veen, J., Kitchen, S., Tuddenham, E., & Makris, M. (2009). Optimizing warfarin reversal--an ex vivo study. Journal Of Thrombosis And Haemostasis: JTH, 7(7), 1123-1127. doi:10.1111/j.1538-7836.2009.03435.x
Tuzson, A. (2009). How high is Too High? INR and Acute Care Physical Therapy. Acute Care perspective, spring, 8-11.
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