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An update of consensus guidelines for warfarin reversal

Warfarin is effectively used in a wide range of thromboembolic disorders for primary and secondary prevention. Patients on long-term therapy have a risk of 1%–3% per year for haemorrhage leading to hospitalisation or death.1,2 Therefore, strategies to manage over-warfarinisation and warfarin during invasive procedures are important.3,4 Despite the associated bleeding risk, warfarin remains the most commonly prescribed anticoagulant in Australia and New Zealand. Common indications for the use of warfarin in the community include stroke prevention in atrial fibrillation (AF), preventing thrombus formation in patients with mechanical heart valves (MHV), and treatment of venous thromboembolism (VTE). For most warfarin indications, the target international normalised ratio (INR) is 2.0–3.0 (VTE and single MHV excluding mitral). For mechanical mitral valve or combined mitral and aortic valves, the target INR is 2.5–3.0.5 New anticoagulants such as oral direct factor Xa inhibitors and direct thrombin inhibitors are becoming available as alternatives to warfarin.6