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Prothrombin complex concentratePCCfresh frozen plasmaor activated Factor VII treatment may be considered if the requirement to reverse the effects of COUMADIN is urgentA risk of hepatitis and other viral diseases is associated with the use of blood productsPCC and activated Factor VII are also associated with an increased risk of thrombosisThereforethese preparations should be used only in exceptional or life-threatening bleeding episodes secondary to COUMADIN overdosage.

The use of vitamin K 1 reduces response to subsequent COUMADIN therapy and patients may return to a pretreatment thrombotic status following the rapid reversal of a prolonged INRResumption of COUMADIN administration reverses the effect of vitamin Kand a therapeutic INR can again be obtained by careful dosage adjustmentIf rapid re-anticoagulation is indicatedheparin may be preferable for initial therapy.

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