Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists?

Journal of Thrombosis and Haemostasis : JTH
A SteibC-M Samama

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

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Citations

Dec 31, 2009·Journal of Thrombosis and Haemostasis : JTH·J D Douketis, A C Spyropoulos
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
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
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
Oct 27, 2017·EFORT Open Reviews·Rafik YassaPaul Dunkow
Dec 4, 2016·Hematology·Sabine Eichinger

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