| Management option | Time to anticoagulation reversal | Comments and cautions |
| Discontinuing warfarin therapy | 5 to 14 days | Five days is typical for patients with an INR in the therapeutic range |
| Vitamin K* | 6 to 24 hours to correct the INR, longer to fully reverse anticoagulation | Recovery of factors X and II (prothrombin) takes longer than 24 hours Risk of anaphylaxis with intravenous injection Impaired response to warfarin lasting up to one week may occur after large doses (ie, >5 mg) |
| Fresh frozen plasma | Depends on the time it takes to complete the infusion; typically 12 to 32 hours for complete reversal | Effect is transient and concomitant vitamin K must be administered Potential for volume overload (2 to 4 L to normalize INR) Potential for TRALI Potential for viral transmission |
| Prothrombin complex concentrate | 15 minutes after 10-minute to 1-hour infusion | Effect is transient, and concomitant vitamin K must be administered; limited availability Cost Variable factor VII content depending on the product: a 4-factor PCC is preferred Potentially prothrombotic |
| Recombinant factor VIIa | 15 minutes after bolus infusion | Effect is transient, and concomitant vitamin K must be administered Cost Potentially prothrombotic |
