Vitamin K will do the job after the FFP/PCC wears off.

FFP or PCC will work only for ~8 hours.

10 mg should be given intravenously, as soon as possible (infused over 30 minutes).

Probably the most important intervention to reverse warfarin is vitamin K.

For patients with intracranial hemorrhage, follow INR every 3-6 hours to ensure adequate reversal.

Alternative: four units fresh frozen plasma.

(1) 10 mg IV vitamin K over 30 minutes *plus* PCC or FFP.

⚠️ For intracranial hemorrhage in a patient on warfarin, PCC should be given immediately without waiting for the INR to result.

Anticoagulation reversal for minor procedures is generally unnecessary.

There is little evidence that moderately elevated INR correlates with post-procedural bleeding after many procedures (e.g., ultrasound-guided central line placement or thoracentesis).

Life-threatening bleeding requires aggressive normalization of coagulation parameters, but minor bleeding may respond to local measures.

How important is it to reverse the anticoagulation? a mechanical mitral valve, which has a high risk of thrombosis). Some patients are anti-coagulated for higher risk conditions (e.g.Short-term interruption is generally fine. Most patients are anti-coagulated for atrial fibrillation or deep vein thrombosis.Why was the patient initially anti-coagulated? Determine what doses of medication the patient is on, and when is the last time a dose was taken.

Review all medications the patient is taking which may affect coagulation (including over-the-counter aspirin or aspirin-containing products).In this situation, thromboelastography (TEG) may be more accurate. For patients with cirrhosis or disseminated intravascular coagulation (DIC), traditional coagulation parameters (e.g., INR) don't necessarily reflect the true coagulation state.Consider all medications and coagulation labs in order to get a global sense of how coagulopathic the patient is. Critically ill patients often have several coagulopathies (e.g., thrombocytopenia plus supratherapeutic INR on warfarin).Considerations when approaching anticoagulation reversal

Antidote for vitamin k toxicity