Wellington ICU Drug Manual: Appendices

appendix 2:
Warfarin reversal guidelines

Wellington ICU Drug Manual - Warfarin Reversal Guidelines

1: 'High-risk' of bleeding factors include active gastrointestinal disorders, concomitant anti-platelet therapy, major surgical procedure within preceding 2 weeks, thrombocytopenia
2: 4FPCC is 4-factor prothrombin complex concentrate (Beriplex). This has replaced prothrombinex-VF (a 3-factor concentrate). Weight-based calculations should be capped at 100 kg (i.e. 5000 I/U is the maximum dose)

Always seek expert haematology advice if unsure

1: 'Bleeding Risk' should be assessed by considering the following criteria: active gastrointestinal disorders, concomitant anti-platelet therapy, major surgical procedure within preceding 2 weeks, thrombocytopenia
2: 4FPCC is 4-factor prothrombin complex concentrate (Beriplex). This has replaced prothrombinex-VF (a 3-factor concentrate). Weight-based calculations should be capped at 100 kg (i.e. 3000 I/U is the maximum dose)

1: 4FPCC is 4-factor prothrombin complex concentrate (Beriplex). This has replaced prothrombinex-VF (a 3-factor concentrate). Weight-based calculations should be capped at 100 kg (i.e. 5000 I/U is the maximum dose)

Outside the peri-operative setting, Beriplex should only be considered if INR > 10 and there is a high risk of bleeding (see Table 2 above)
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Source: Updated recommendations for warfarin reversal in the setting of four‐factor prothrombin complex concentrate. MJA 2025

Source: NZ Blood Warfarin Reversal guidelines using Beriplex® NZ

Source: An update of consensus guidelines for warfarin reversal. MJA 2013