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Upper gastrointestinal bleed

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Causes
Clinical features
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Therapy

If your patient's prothrombin time is prolonged (or INR raised) consider giving 5 mg vitamin K by slow (5 minute) iv infusion a (Clinical response takes 4 to 6 hours) c  

Why?

  • Few patients on steady-state warfarin dosing have normal INRs within 3 days of stopping. Most have normal INRs within 8 days. The INR declines more slowly in older patients. c
  • Vitamin K lowers INR effectively c
  • Intravenous vitamin K leads to a faster response than subcutaneous. a

Expiry date: July 2003
Levels of Evidence used in grading these guides

Author   A   Townsend , CM   Ball
Reviewer   L   Friedman
CAT Writers   A   Townsend , CM   Ball , CJ   Wotton