For the emergent reversal of anticoagulation, there is only one dose and one route of vitamin K that should be used: 10 mg of IV vitamin K infused over 30 minutes. Conversion to warfarin: Since dabigatran contributes to INR elevation, warfarin’s effect on the INR will be better reflected only after dabigatran has been stopped for ≥2 days. Whenever possible, anticoagulation should be resumed in a timely manner to avoid thromboembolic complications related to the underlying indication for anticoagulation. The INR and either the extent of bleeding or timing of surgical intervention should be used to determine the level of warfarin reversal.2 Table 2 provides common clinical scenarios and reversal options. Reversal of warfarin with Vitamin K should be reserved only for the most serious bleeding events or patients who will not be restarted on warfarin. Vitamin K should be administered either orally or intravenously (IV) only. Oral Vitamin K is the safest and most reliable route. In elective surgery, either omission of warfarin alone or with co-administration of vitamin K is the recommended pathway for warfarin reversal. Outside of the peri-operative setting, Beriplex® should only be considered if INR 10, and there is a high risk of bleeding. Regardless of the reason for anticoagulation, major haemorrhage in a patient on the anticoagulant warfarin is best managed by rapid and complete reversal with a prothrombin complex concentrate and intravenous (IV) vitamin K Whenever possible, antithrombotics should be resumed in a safe, timely manner through shared decision making to avoid thromboembolic complications. Clearance is reduced and half-life is prolonged in renal dysfunction. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 PDF. Only certain medications (e.g., heparin and warfarin) or with certain reversal medications (e.g. idarucizumab and andexanet alfa) can cause pharmacological reversal. If factor concentrates are used, they create a pro-thrombotic state and do not reverse the action of the drug.