Warfarin (Vitamin K Antagonist) Reversal

• IV vitamin K

  • 10 mg (rate not to exceed 1 mg/min)

• Kcentra (4-factor PCC)

  • INR 2-3.9: 25 U/kg (max 2500 U)

  • INR 4-6: 35 U/kg (max 3500 U)

  • INR >6: 50 U/kg (max 5000 U)

• Consider Supplementing with FFP

  • 10-20 mL/kg (1 unit = 200 mL; typical adult dose = 4-5 units)

• Monitoring

  • Following PCC administration, recheck INR at

    • t = 15 minutes

    • t = 2 hours

    • q6 hours thereafter