Quick recap on our recent Podcast Episode on Superwarfarin..

Let’s talk about diarrhea for 60 seconds

Superwarfarin reversal is a long game. Vitamin K may be required for months. Discharge only when bleeding is controlled and the oral regimen is stable; taper under lab guidance to avoid rebound INR elevation and recurrent bleeding.

Critical INR without major bleeding is a different pathway: vitamin K is primary therapy. We prefer high-dose oral vitamin K in stable patients, which avoids unnecessary PCC or FFP. Follow with serial INRs.

Major bleeding from superwarfarin needs immediate factor replacement plus sustained reversal. The recommendation is 4F-PCC with concurrent IV vitamin K, then reassess INR and clinical bleeding. Use FFP if PCC is unavailable.

A massive unexplained INR in a patient not taking warfarin, with relatively normal liver tests and platelets, should raise concern for SUPERWARFARIN. Do not delay treatment while awaiting specialized confirmatory testing.

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Mechanical CPR may help when manual compression quality is difficult to maintain, such as transport, prolonged extrication, confined spaces, or limited personnel. That is an operational rationale, not proven survival benefit. Keep this in mind during your next resuscitation 🧠