Transition to Vitamin K Antagonist Coumarin Therapy

Recommendation. To minimize the risk of coumarin necrosis in a patient with acute HIT, vitamin K antagonist (coumarin) therapy should be delayed until the patient is adequately anticoagulated with a rapidly acting parenteral anticoagulant, and not until there has been substantial platelet count recovery (at least > 150 X 109/L). The vitamin K antagonist should be started in low maintenance doses (e.g., < 5 mg warfarin), with at least 5 days of overlap with the parenteral anticoagulant (including at least 2 days in the target-therapeutic range), and the parenteral anticoagulant should not be stopped until the platelet count has reached a stable plateau (Grade 1C).

Recommendation. Oral or iv vitamin K should be given to reverse coumarin anticoagulation in a patient recognized as having acute HIT after coumarin has been commenced (grade 1C).

Recommendation. Prothrombin complex concentrates should not be used to reverse coumarin anticoagulation in a patient with acute or recent HIT unless bleeding is otherwise unmanageable (grade 2C).

0 0

Post a comment