Reversal of asymptomatic over-anticoagulation by orally administered vitamin K

British Journal of Haematology
Peter BakerDavid Keeling

Abstract

Over-anticoagulation with warfarin is common. There is good reason to reverse significantly high international normalised ratios (INRs), however, in practice, there is wide variation in the means to achieve this. Randomised controlled trials have provided evidence for using low dose orally administered phytomenadione for the reversal of asymptomatic over-anticoagulation. We devised an oral regimen using the intravenous preparation of phytomenadione (vitamin K1). Patients with an asymptomatic INR between 8.0 and 11.9 (n = 166) received 2.5 mg and those with an INR of 12.0-20.0 (n = 36) or >20 (n = 21) received 5 mg. Median INRs for the three groups of patients on day 1 (approximately 14 h) after vitamin K administration were 3.5, 3.0 and 2.9 respectively. In the patients given 2.5 mg, 77% had INRs between 2.0 and 4.9 on day 1. In the patients given 5 mg, 52% of those presenting with INRs of 12.0-20.0 returned between 2.0 and 4.9 1 d after administration of vitamin K. In the INR >20 group 44% returned with an INR between 2.0 and 4.9. Warfarin was reintroduced once the INR was <5 and the majority of patients remained stable for the following 14 d. This regimen for non-urgent correction is therefore effective and returns patients t...Continue Reading

References

Jul 6, 1995·The New England Journal of Medicine·S C CannegieterE Briët
Sep 2, 1993·The New England Journal of Medicine·M H EckmanS G Pauker
Jun 3, 1998·British Journal of Haematology
Sep 1, 2001·British Journal of Haematology·M Makris, H G Watson
Mar 3, 2004·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Sarah E WilsonMark A Crowther
Nov 2, 2004·The Medical Journal of Australia·Ross I BakerUNKNOWN Warfarin Reversal Consensus Group

❮ Previous
Next ❯

Citations

Jul 24, 2012·Disease-a-month : DM·S Kate Hartman, Jun Teruya
Dec 17, 2009·Journal of Clinical Anesthesia·Naveen EipeImad T Awad
Oct 24, 2006·British Journal of Haematology·S K ChirputkarR C Tait
Jun 16, 2011·British Journal of Haematology·David KeelingUNKNOWN British Committee for Standards in Haematology
Oct 14, 2014·Journal of Thrombosis and Haemostasis : JTH·N van ReinF J M van der Meer
Sep 27, 2012·American Journal of Clinical Pathology·Monica B Pagano, Wayne L Chandler
Dec 26, 2017·Hospital Pharmacy·Janna Afanasjeva
Dec 4, 2016·Hematology·Sabine Eichinger
Apr 30, 2015·Journal of Orthopaedic Surgery·Thomas Steven MooresPhilip John Roberts
Nov 10, 2021·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Jordan H RiceRegan A Baum

❮ Previous
Next ❯

Related Concepts

Related Feeds

Blood Clotting Disorders

Thrombophilia includes conditions with increased tendency for excessive blood clotting. Blood clotting occurs when the body has insufficient amounts of specialized proteins that make blood clot and stop bleeding. Here is the latest research on blood clotting disorders.