{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Ta de Clinicagem","title":"TdC em Bolus - Como Manejar Intoxicação por Varfarina","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/46edf260\"></iframe>","width":"100%","height":180,"duration":895,"description":"O uso da Varfarina é extremamente comum na nossa prática clínica e precisamos saber como manejar sua intoxicação. Kaue e Rapha conversam sobre essa intoxicação em 3 situações - Paciente com sangramento grave, sangramento leve e o paciente com RNI (ou INR) alterado mas sem sangramento.\nReferências:\n\n Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 2009; 150:293.\n Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv 2018; 2:3257.\n Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:160S.\n Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83:137.\n  Gunther KE, Conway G, Leibach L, Crowther MA. Low-dose oral vitamin K is safe and effective for outpatient management of patients with an INR>10. Thromb Res 2004; 113:205.\n  Farrow GS, Delate T, McNeil K, et al. Vitamin K versus warfarin interruption alone in patients without bleeding and an international normalized ratio > 10. J Thromb Haemost 2020; 18:1133.\n  Refaai MA, Goldstein JN, Lee ML, et al. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion 2015; 55:2722.\n  Goldstein JN, Refaai MA, Milling TJ Jr, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 2015; 385:2077.\n  Hylek EM, Regan S, Go AS, et al....","thumbnail_url":"https://img.transistorcdn.com/lqcQlEC1m6aWV5CJqKTqNKKWbLXziZKK97FisF4ZuuE/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9lODM1/ZmI0ODIxZjAxM2U1/ZGUwMjhkYTYwNzZi/MGNmNi5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}