Recommended dosing of oral anticoagulants (OAC) in neonates and children.
| OAC . | Day 1 . | Day 2 . | From Day 3 . | Target INR . |
|---|---|---|---|---|
| Phenprocoumon | 6 mg/m2 | 3 mg/m2 | 1–2 mg/m2 | 2.0–3.0 |
| Warfarin | 0.2 mg/kg | 0.2 mg/kg | 0.1–0.3 mg/kg | 2.0–3.0 |
| OAC . | Day 1 . | Day 2 . | From Day 3 . | Target INR . |
|---|---|---|---|---|
| Phenprocoumon | 6 mg/m2 | 3 mg/m2 | 1–2 mg/m2 | 2.0–3.0 |
| Warfarin | 0.2 mg/kg | 0.2 mg/kg | 0.1–0.3 mg/kg | 2.0–3.0 |
| Reversal of oral anticoagulant therapy . | |
|---|---|
| Coumarin therapy always to begin with concomitant heparin therapy (UFH or LMWH); to stop heparin, INR within therapeutic range for 2 days, concomitant medication at least 5 days; attention to multiple drug interactions | |
| no bleeding, slow reversal | vitamin K 0.5–2.0 (−5.0) mg orally (s.c., i.v.) |
| no bleeding, rapid reversal | vitamin K 0.5–2.0 (−5.0) mg s.c. or i.v. |
| significant bleeding, not life threatening | vitamin K 0.5–2.0 (−5.0) mg s.c. or i.v. + FFP 20 mL/kg |
| significant bleeding, life threatening | vitamin K 5 mg i.v. over 20 min. (risk of anaphylactic shock) + prothrombin concentrate (Prothomplex) 50 U/kg i.v. |
| Reversal of oral anticoagulant therapy . | |
|---|---|
| Coumarin therapy always to begin with concomitant heparin therapy (UFH or LMWH); to stop heparin, INR within therapeutic range for 2 days, concomitant medication at least 5 days; attention to multiple drug interactions | |
| no bleeding, slow reversal | vitamin K 0.5–2.0 (−5.0) mg orally (s.c., i.v.) |
| no bleeding, rapid reversal | vitamin K 0.5–2.0 (−5.0) mg s.c. or i.v. |
| significant bleeding, not life threatening | vitamin K 0.5–2.0 (−5.0) mg s.c. or i.v. + FFP 20 mL/kg |
| significant bleeding, life threatening | vitamin K 5 mg i.v. over 20 min. (risk of anaphylactic shock) + prothrombin concentrate (Prothomplex) 50 U/kg i.v. |