FFP vs. Vitamin K

[Babycatcher2B]

I am so freaking confused about when to give Vitamin K vs. FFP in liver dz or warfarin toxicity. Pt bleeding? pt not bleeding? Pt needing to go to surgery? I understand that Vitamin K works slower than FFP and if the liver is shot then the Vitmain K won't work. But I am still a bit confused, can anybody help?

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[rox]

I'm not quite sure, but if the patient is not bleeding you probably withhold warfarin only. FFP for the acute setting.

 

[IzzyMD09]

i think i can help with this one maybe but someone double check on me

i had the same problem with UWorld

bottom line is this

Vitamin K can be good to make the factors work, but it ONLY works if the liver works, cause thats where the gamma carboxylation whatever goes on
if the liver is cirrhotic give FFP,

In warfarin toxicity, give Vitamin K, it reverses the inhibition of vitamin K via overload mechanism, if the patient needs to go to surgery and is on warfarin, discontinue warfarin, and give vitamin k and check platelet count PT PTT, see where the problem is in the coag cascade and aggregation with BT, and correct it

if pt is bleeding platelets are low and it is a factor problem (besides factor 8 which is vWF) give platelets and FFP

 

[EternalMD]

with warfarin toxicity (implying sympatomaticity - is that even a word?), i'm pretty you would just go straight to the FFP rather than the Vit K route

and if the patient just has a really high INR and is asymptomatic, stop the warfarin and then its just a question of Vit K or not Vit K. I suppose it depends on the question stem and answer choices

 

[IzzyMD09]

i think you would want to neutralize warfarin in the plasma i.e. overloading its active sites with more vitamin K increases unbound vitamin K to gamma carboxylate factors, it may take a while, and I think FFP is needed too

but i think it all depends on the scenario

if its emergent FFP, if not Vit K

and yes you are pretty eternalmd

 

[bjackrian]

Izzy has it exactly right. If it's urgent (e.g., ongoing bleeding, hemodynamic compromise, etc.) give FFP. Give Vitamin K in all cases to cover you in the future, but even with good synthetic liver function, it takes hours-days (depending on the factor) to restore a normal coagulation profile.

 

[IzzyMD09]

i hope you double checked me, I dont even know which way is up after completing 90% on this thing