Title：Reversal of warfarin in 2012
题目：2012年纠正华法令过量的指南
Author 作者：Ellen Lemkin

I. INR can be influenced by a number of factors
INR可能会收到几方面因素的影响
400 drug-drug interactions with warfarin
有400个药物会与华法令有相互反应
b. Food 食物
c. Alcohol 饮酒
d. Disease states 疾病状态
II. 2 major categories for patients with elevated INR
INR增加的病人可分两类
No bleeding or minor bleeding
没有或有轻微出血
Major bleeding
大出血
III. No bleeding and mildly elevated INR (INR of 3 – 5)
没有出血，INR轻度增高（3－5）
Spontaneous events are uncommon
自发性出血不常见
Relative risk is 2.7 of spontaneous bleeding events
自发性出血的危险因子为2.7
Most patients can just have their warfarin held for a day or two
许多病人只要停药1－2天就可以了
Consider treatment in patient with some risky disease states
有下列几个危险疾病状态的要考虑治疗
i. Advanced age 年纪很大
ii. Active malignancy 活动期的恶性肿瘤
iii. CHF 心衰
Can give IV or oral vitamin K 2.5 mg
可以静脉或口服维生素K2.5mg
IV. No bleeding and significantly elevated INR (INR > 5)
没有出血，INR明显增高（超过5）
Relative risk of spontaneous bleeding goes up to 21.8
自发性出血的危险因子高到21.8
Give IV or oral vitamin K2.5–5mg
可以静脉或口服维生素K5mg
Should not give subcutaneous vitamin K ever
任何时候都不要皮内注射维生素K
V. Minor bleeding and elevated INR
轻度出血，INR升高
a. Hold warfarin 停用华法令
b. Give IV or oral vitamin K 5 mg
静脉或口服维生素K 5mg
VI. Major bleeding and elevated INR
大出血，INR升高
Vitamin K IV 10 mg slowly
缓慢静脉注射维生素K 10mg
Minor risk of anaphylaxis (3 out of 10,000 patients)
很小的比例出现过敏性反应（1万个病人里有3个）
Fresh frozen plasma or FFP
新鲜冰冻血浆（FFP）
10-15 mL/kg dosing
剂量：10－15ml／kg
Takes a little time to work and to get ready
不需要太长的时间准备
Readily available in most hospitals
很多医院都有
Prothrombin complex concentrate or PCC
凝血酶原复合物浓缩剂（PCC）
Has more vitamin K clotting factors
含更多的维生素K因子
Version available in the US only has 3 factors and very little factor VII
美国市场的PCC主要含3个因子，非常少的第VII因子
Usually has to be given in combination with factor VII
一般要与因子VII同时给
Has a 1.8% risk of arterial thrombosis
动脉血栓的危险为1.8％
Recombinant activated factor VII
生物合成的活性因子VII
Short half-life of 2 – 6 hours
半衰期为2－6小时
Higher risk of arterial thrombosis, 10%
较高的动脉血栓形成，10％

References 参考文献:
Garcia DA, Crowther MA. Reversal of warfarin, case-based practice recommendations.
Circulation. 2012; 125: 2944-2947.