An update of consensus guidelines for warfarin reversal

In reply: Badami suggests that international normalised ratio (INR)-based prothrombin complex concentrate (PCC) dosing for warfarin reversal may not be clinically useful and is cumbersome to use. We agree that the INR variably reflects factor II, VII, IX and X activity in patients on warfarin therapy. However, the INR is a rapid, valid and readily available test, and an INR-based PCC dosing regimen provides guidance on how to manage patients on warfarin therapy who have major bleeds or need urgent surgery. We acknowledge that further validation of the INR-based dosing regimen is needed, but only a randomised trial comparing INR-based dosing with fixed-dose PCC treatment will give clarity.