Beriplex P/N contains heparin and is contraindicated in patients with heparin induced thrombocytopenia (present or previous). Contact Haematology to discuss alternatives, e.g. FFP.

Beriplex P/N is also relatively contraindicated in patients with:

1. An increased risk of thrombosis
2. Angina pectoris and after recent myocardial infarction

In all clinical situations an assessment of the likely risks and benefits of administration needs to be made.

In disseminated intravascular coagulation, prothrombin complex-preparations (e.g. Beriplex P/N) may only be administered after termination of the consumptive state.

Intravenous vitamin K (phytomenadione) may rarely cause anaphylaxis. The Konakion MM 10mg/mL should be used for intravenous administration. Administration should be:

• By slow IV bolus (see IV Manual for directions for administration) http://intranet.lothian.scot.nhs.uk/NHSLothian/Healthcare/A[1]Z/MedicinesManagement/DrugsTherapeutics/Documents/Guidelines/NHS% 20Lothian%20UK%20IV%20Guide.pdf
• Withheld in patients with a history of previous severe allergic reaction to vitamin K.

The preparation used is Konakion MM Paediatric, which comes in a concentration of 2mg/0.2mL. The oral syringes provided with each pack should be used to measure the required volume to be given orally. These syringes explicitly state 1mg and 2mg on the markings.

Standard risk patients do not require INR reversal at INR 5.0-7.9 but correction should be considered in “high risk” patients whose risk of bleeding is approximately 15 fold higher.

• Elderly and frail (>65)
• Previous GI bleed
• Previous CVA (haemorrhagic or ischaemic)
• Anaemia (Hb <10g/l)
• Renal failure (CrCl <30)
• Diabetes mellitus
• Previous MI