- Stop anticoagulant.
- Assess for and manage comorbidities that might contribute to bleeding, such as, thrombocytopenia, uremia, or liver disease.
- Provide supportive care with volume resuscitation (IV fluids) and hemodynamic support (inotropes, monitoring) as needed.
- Initiate local or surgical hemostatic measures to control bleeding.
- Red blood cell transfusion as needed.
- Administer vitamin K 5-10 mg IV
- Consider administering 4-factor prothrombin complex concentrate (PCC):
- 25 units/kg for INR 2-4
- 35 units/kg for INR 4-6
- 50 units/kg for INR > 6
- Recombinant factor VIIa (rFVIIa) is not recommended.
American Society of Hematology 2018 guidelines:
2012 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines: