n by Level of Supporting Evidence and Direction of Interaction CNS Drugs
GI Drugs and Food
Sushi containing seaweed
Propofol Warfarin Strategies
ÎFor patients taking VKAs with INRs between 4.5 and 10 and with no evidence of bleeding, we suggest against the routine use of vitamin K (2B).
ÎFor patients taking VKAs with INRs > 10.0 and with no evidence of bleeding, we suggest that oral vitamin K be administered (2C).
ÎFor patients initiating VKA therapy, we suggest against the routine use of clinical prediction rules for bleeding as the sole criterion to withhold VKA therapy (2C).
ÎFor patients with VKA-associated major bleeding, we suggest rapid reversal of anticoagulation with four-factor PCC rather than with plasma (2C). We suggest the additional use of vitamin K 5-10 mg administered by slow IV injection rather than reversal with coagulation factors alone (2C).
Warfarin Reversal Strategies D/C Warfarin
Green tea Herbal Supplements Other Drugs
Cyclosporine Etretinate Ubidecarenone
INR 4.5-10
INR > 10
Major Bleed
D/C VKA only (2B)
Vit K PO (2B)
Vit K 5-10 mg slow IV (2B)
Four-factor PCC +
