Over-Anticoagulation
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þ Recombinant Factor VIIa
 - significant thromboembolic complications
 - usual dose is 90 mcg (9 mg) IV Q2H until bleeding stops but varies widely

þ FFP:
 - Just need blood type to start thawing.
 - For outside patients coming to ED, can get blood type and start thawing
   FFP.

þ Treatment of too much Coumadin
 - ACCP (American College of Chest Physicians) recommends IV Vitamin K if INR
   is 6 or more (asymptomatic patients).  But IV Vitamin K (at least the older
   preparations) can cause anaphylaxis, and IM works as quickly.  This study
   found that giving vitamin K made no difference in terms of number of
   bleeding complications, but made re-anticoagulation difficult.  Suggests
   that it's safe to manage patients with high INRs (mean in this study was
   11.1, high INR was 80.9!) without Vitamin K.  [Glover JJ, et al.
   Conservative treatment of overanticoagulated patients. Chest 1995;
   108(4):987.]

 - 2.5-10 mg or up to 25 mg (rarely 50 mg) IM or SQ