Yesterday I published a protocol that Regions Hospital uses for rapid reversal of warfarin in patients with life-threatening bleeding. This is very useful in trauma patients, but a number of other specialties use it as well (GI, etc). But what about that patient who doesn’t have a major bleeding problem, but needs emergency surgery or some invasive procedure? If something isn’t done prior to the case, the surgeon or interventionalist may inflict life-threatening bleeding!
We use a variant of the protocol I posted yesterday. The differences arise from the fact that, in this case, there is a little bit of time to find out some of the patient’s medical history. Certain things may modify the protocol, or contraindicate it entirely, such as:
- Is the patient in DIC?
- Do they have heparin induced thrombocytopenia (HIT)?
- Do they have a history of significant peripheral vascular disease or thrombotic tendencies?
- Will they need to be re-anticoagulated afterwards?
Again, feel free to download this protocol and modify it as you wish. Comments and questions are welcome!