Abstract
After a vitamin K antagonist (VKA) overdose, 1-2 mg of oral vitamin K can lower the International Normalized Ratio (INR) to the therapeutic range. To establish whether oral vitamin K can substitute for heparin bridging and decrease the INR to < or = 1.5 before elective surgery. Patients on long-term VKAs were randomized either to heparin bridging after the last VKA dose on day -5 before surgery (group H) or to VKA treatment until day -2, followed by 1 mg of oral vitamin K on the day before surgery (group K). Blood clotting variables were assessed on days -5/-2, 1 and 0, and postoperatively. If the target INR was not achieved 2 h before incision, surgery was deferred or performed after injection of prothrombin complex concentrate (PCC). In 30 of 94 included patients, baseline INR was outside the chosen range (18, INR < 2; 12, INR > 3.5), leaving 34 eligible patients in group H and 30 in group K. The groups were balanced in terms of body mass index, VKA treatment duration and indication, scheduled surgery, preoperative and postoperative hemoglobin, and blood loss. The INR was significantly higher in group K on days -1 and 0 than in group H. An INR < or = 1.5 was not achieved in 20 group K patients (66%). Surgery was postponed or ...Continue Reading
References
Dec 1, 1987·Journal of Pharmacokinetics and Biopharmaceutics·D J Schuirmann
May 22, 1997·The New England Journal of Medicine·C Kearon, J Hirsh
Jun 15, 1997·Annals of Internal Medicine·R T WeibertS I Rapaport
Nov 4, 1998·Archives of Internal Medicine·A M WhitlingR M Lyons
Dec 22, 1999·Archives of Internal Medicine·G RajW P McKinney
Jan 1, 1997·Journal of Thrombosis and Thrombolysis·M T BrophyD Deykin
Jul 11, 2000·British Journal of Haematology·A HungR C Tait
Oct 18, 2000·Pharmacotherapy·R J PatelD S Wilkinson
Nov 15, 2000·Lancet·M A CrowtherJ Ginsberg
Aug 21, 2002·Annals of Internal Medicine·Mark A CrowtherWalter Ageno
Feb 15, 2003·Thrombosis Research·James D Douketis
Mar 1, 2003·The Journal of Emergency Medicine·Christina Wjasow, Robert McNamara
Apr 30, 2003·Archives of Internal Medicine·Andrew S Dunn, Alexander G G Turpie
Nov 12, 2003·Archives of Internal Medicine·Clive Kearon, Jack Hirsh
Jul 3, 2004·Blood·Leon J SchurgersCees Vermeer
Mar 1, 2006·Archives of Internal Medicine·Kent J DezeePatrick G O'malley
Sep 12, 2006·Journal of Thrombosis and Haemostasis : JTH·F DentaliM Crowther
Oct 18, 2006·European Journal of Haematology·Elizabeth A Sconce, Farhad Kamali
Mar 24, 2007·Journal of Thrombosis and Thrombolysis·Karen WoodsMark A Crowther
Mar 14, 2008·Journal of Thrombosis and Thrombolysis·G DenasVittorio Pengo
Jul 24, 2008·Chest·Jack AnsellGualtiero Palareti
Jul 24, 2008·Chest·James D DouketisJack Ansell
Mar 5, 2009·Annals of Internal Medicine·Mark A CrowtherClive Kearon
Citations
Aug 27, 2014·European Heart Journal·Gregory Y H LipJose L Zamorano
Feb 15, 2012·Chest·James D DouketisRegina Kunz
Jul 16, 2010·Thrombosis Research·Gilles PernodUNKNOWN French National Authority for Health
Jul 15, 2011·British Journal of Haematology·Kate L BurburyDavid A Westerman
Dec 31, 2009·Journal of Thrombosis and Haemostasis : JTH·J D Douketis, A C Spyropoulos
May 27, 2015·Journal of Thrombosis and Haemostasis : JTH·S AbohelaikaF Kamali
Mar 12, 2015·Age and Ageing·Salah AbohelaikaFarhad Kamali
Feb 26, 2015·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Valerio ZacàGiancarlo Casolo
Nov 8, 2013·Thrombosis Research·Benjamin BueckingUlrich J Sachs
Mar 10, 2015·Drugs in R&D·Timo PurmonenHannu Kokki
Aug 3, 2012·Blood·Thomas L Ortel
Mar 19, 2011·Blood·James D Douketis
Feb 1, 2015·International Journal of Hematology·Ashrei BayewitzHenny Heisler Billett
Nov 7, 2015·Journal of Cardiothoracic Surgery·James P Bailey
Oct 8, 2016·British Journal of Haematology·David KeelingUNKNOWN British Committee of Standards for Haematology
Jul 22, 2011·The Annals of Pharmacotherapy·William E Dager
Jun 13, 2012·Circulation·David A Garcia, Mark A Crowther
Jun 14, 2017·World Journal of Surgery·Frédérique HovaguimianDonat R Spahn
Dec 19, 2019·Journal of Thrombosis and Thrombolysis·Emmanouela KampourakiFarhad Kamali
Jul 7, 2020·Hospital Practice·Goutham TalariScott Kaatz
Jul 6, 2019·Cardiology Research and Practice·Johnny ChahineSamer Nasr
Nov 8, 2011·Hospital Practice·James D Douketis
Oct 27, 2017·EFORT Open Reviews·Rafik YassaPaul Dunkow
Dec 4, 2016·Hematology·Sabine Eichinger