A Retrospective Evaluation of Vitamin K₁ Therapy to Reverse the Anticoagulant Effect of Warfarin

Abstract

The most frequently prescribed administration routes for vitamin K1 were subcutaneous and intravenous, indicating that the oral route is often not used as recommended. The vitamin K1 doses prescribed for reversal of warfarin anticoagulation were highly variable, and for most (83%) patients, the recommended guidelines were not followed. The clinical significance of noncompliance with the ACCP guidelines for vitamin K1 administration warrants further study.

Adherence to guidelines for the management of excessive warfarin anticoagulation

“…These evaluations were all conducted using versions of the ACCP guidelines that preceded the seventh (2004) version, although recent revisions have not been substantive. Utilizing a larger sample size than the majority of these studies [17][18][19][20][21], the results of our study are consistent with these earlier reports, in finding that there is poor adherence to current guidelines, primarily in that doses of vitamin K1 are too high in those whose INR is \9.0, and routes of administration are inappropriate.…”

“…The findings in three retrospective reviews have been similar [19][20][21]. Fan found adherence to the ACCP guidelines in only 17% of cases of overanticoagulation; 40% of vitamin K1 doses were administered by SQ injection [19]. Atreja found that adherence to the guidelines decreased as INR increased-from 66 to 36% [20].…”

“…[17] Wilson found that doses of vitamin K1 used were higher than recommended, and the route of administration was frequently SQ [18]. The findings in three retrospective reviews have been similar [19][20][21]. Fan found adherence to the ACCP guidelines in only 17% of cases of overanticoagulation; 40% of vitamin K1 doses were administered by SQ injection [19].…”

“…Results of surveys [17,18] and retrospective chart reviews [19][20][21][22] have revealed poor adherence to previously published versions of these guidelines, and underutilization of oral vitamin K1 [17][18][19][20][21][22]. This study assesses adherence to the ACCP guidelines for treating warfarin-associated coagulopathy.…”

An Evaluation of Intravenous Vitamin K for Warfarin Reversal: Are Guideline Recommendations Being Followed?

“…12,13 Van Berkel et al examined the impact of a multifaceted education on improving prescribing practices of vitamin K for warfarin reversal. Their study demonstrated an increase in adherence from 25% to 55.8% after implementation of the education based on the 2008 guidelines.…”