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16. xGuideline of Treatment
Suspect warfarin overdose
1.Check PT INR, CBC (1" #/(1)
2.S/S of bleeding (1" #/(2)
3.Review dose of warfarin and indication
4.Other medication, antiplatelet, NSAID
5.Underling liver, renal disease
Above therapeutic but <5.0
>5.0 but < 9.0
No bleeding
No bleeding
Admit ward
-Old age > 70 Yrs
-Poor compliance
-Previous bleeding
complication
Admit ward
-Lower dose or stop
-Monitor PT INR
-Notify resident CVT or staff
(Admit ward)
-Stop warfarin
-Monitor PT INR
-Notify
resident/staff CVT
(D/C)
-no bed
-no S/S of major
bleeding
-good complicance
education
-no Hx of bleeding
-F/U OPD early visit
-Admit
-stop warfarin
-Vitamin K 5-10 mg.
-Monitor PT INR in 24
hrs
-Notify resident or staff
CVT
Admit
-stop warfarin
-Vitamin K 10 mg.
-FFP
-Monitor PT INR & control in 24
hrs.
-Notify resident/staff CVT
D/C
F/U OPD CVT
#/()%3+#/(S26"@1"$7%
Staff 7+ N+
Lower dose
or
Stop warfarin
Major bleeding but not serious
Patient evaluation risk
Low risk High risk
-Age > 70
-Hx stroke
TIA
UGIB
-Hepato renal
failure
-On antiplatlet
Major bleeding

17. W>9.0
-admit ward
-stop warfarin
-vitamin K 10 mg.
-monitor PT INR
-notify resident/staff CVT
-admit
-stop warfarin
-vitamin K 10 mg.
-FFP
-monitor PT INR
-notify resident/staff CVT
-admit
-stop warfarin
-vitamin K 10 mg.
-FFP
-monitor PT INR
-notify resident/staff CVT
%";/ Intra cranial ]E
- notify staff X-Ray
-CT brain Ergent
- 14210Refer
- +Refer N:0N2+admit obsevere ICU
!21+notify staff CVT %0 <@(6 1/
10N
No bleeding Major bleeding
or Major bleeding
-resuscitation shock
-ET if ressesity
-vitamin K 10 mg.
FFP
-G/M
-notify staff/resident CVT !220$
-Admit ICU
-Life threatening bleeding
-hemodynamic unstable
-stroke
-suspect intracranial ]E
***
>20 (very high PT INR )(confirm not error) Any PT INR

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