Do any of you have a formal "protocol" for warfarin reversal?  I believe that this is an order in the computer that the MDs can choose that includes a bunch of if/then options.  Protocol algorithms have to be approved by various medical committees before they can be created in our computer system.  We had a locum ED doc ask about a protocol and also had a doc get confused and order plts when he meant plasma which already had us thinking about it.  There are some nice guidelines which delineate the doses and timing of Vit K and plasma depending on the urgency and risk of bleeding which I think could be made into a protocol.  There also is a role for K-Centra in there at some point.  Obviously the hematologists (and others who so choose) can order in a more nuanced way, but it could guide those docs who don't spend all of their time in the coag world.  It might even help with more appropriate use of plasma.  If anyone is using such a protocol I would appreciate a copy of it.

We're working on one too; here's a few that should help you.

Warfarin Reversal Guideline 2012.pdf

Warfarin Reversal article.pdf

Warfarin_Reversal_Vitamin_K.pdf

Coumadin_Warfarin_Therapy_Reversal_in_Patients_with_Risk_for_or_Actual_Extracranial-Intracranial_Hemorrhage.doc

Thanks for bringing this topic to light, Mabel. This relates to a Joint Commission Patient Safety goal:  2014 NPSG.03.05.01

 

Thank you for sharing the links, Terri.

I beileve K-Centra is relatively 'mainstream' now and stocked in many hospital pharmacies. However, most docs are reticent to use it due to cost. We had a patient yesterday get 5 units of group AB plasma to correct an INR of 2.5 (pt. was on anticoagulation therapy due to A Fib) so that he could have hip surgery.

I thought this would be the perfect situation for K-Centra.

How are your docs using or not using K-Centra? Do they seem concerned about the cost?

We have an excel programme developed by our blood bank manager. It caluclates the dosage based on INR and weight and gives the correct amount of PCC to give. You then print the sheet and attach it to the paperwork.

We got approval this year from our Pharmaceuticals and Therapeutics committee to expand the use of KCentra from warfarin reversal in life-threatening bleeds only to include using it for patients at risk of circulatory overload from all that plasma when they need immediate reversal or when they need reversal faster than the time it takes to transfuse that much plasma. We still don't have an official protocol I don't think.  Hmm.  Time to get back on that maybe.