Anaphylaxis after low dose intravenous vitamin K

Wjasow, Christina; McNamara, Robert M.

doi:10.1016/s0736-4679(02)00720-5

Cited by 22 publications

(17 citation statements)

References 14 publications

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“…6 The vitamin K1 prescribing information recommends a dose of 2.5 to 10 mg or up to 25 mg, dilution in 0.9% sodium chloride, 5% dextrose or 5% dextrose and sodium chloride, and slow infusion with a maximum rate of 1 mg per minute. 4,5 Although higher doses of vitamin K1 may be associated with an increased risk of reaction, reactions have been reported at doses as low as 0.5 to 1 mg. 17,18,21,33 Both ADRs reported by Shields et al occurred with a 0.5 mg dose, suggesting that avoidance of higher doses is not completely protective against these reactions. 17 Similarly, Riegert-Johnson and Volcheck reported anaphylactic reactions in 2 patients, both of which occurred with 0.5 mg doses.…”

Section: Discussionmentioning

confidence: 95%

“…Reported doses administered ranged from 0.5 to 100 mg, with only 3 patients receiving doses above those recommended in the prescribing information and guidelines (>10 mg). [4][5][6][7][8] Three reactions resulted in death, 20,21,30 whereas 1 reaction resulted in fetal death.…”

Section: Case Reportsmentioning

confidence: 99%

“…18,21,23,24,26,30,31 Of these, 3 also met the suggestions of the American College of Chest Physicians (ACCP) guidelines with total infusion times of at least 20 minutes. 18,26 Of the 10 reactions detailing previous vitamin K1 exposure, 6 had previously received some form of vitamin K1.…”

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confidence: 99%

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Characterizing the Severe Reactions of Parenteral Vitamin K1

Britt

Brown

2016

Clin Appl Thromb Hemost

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Parenteral vitamin K1 (phytonadione) is used for anticoagulant reversal, and a boxed warning exists with intravenous and intramuscular administration due to the possibility of severe reactions, including fatalities. These reactions resemble hypersensitivity or anaphylaxis, including anaphylactoid reaction, and have led to shock and cardiac and/or respiratory arrest. The objective of this review is to summarize the available literature detailing the anaphylactic/anaphylactoid reactions with parenteral vitamin K1 in order to better characterize the reaction and provide a more in-depth understanding of its importance. A comprehensive literature search of MEDLINE (1946 to June 2016) and EMBASE (1947 to June 2016) was conducted using the terms vitamin K1, phytonadione, phytomenadione, vitamin K group, anaphylaxis, polyoxyethylated castor oil, and cremophor. A total of 2 retrospective surveillance studies, 2 retrospective cohort studies, and 17 case reports were identified for inclusion and assessment. Based on a review of the literature, use of parenteral vitamin K1 may result in severe hypotension, bradycardia or tachycardia, dyspnea, bronchospasm, cardiac arrest, and death. These reactions are most consistent with a nonimmune-mediated anaphylactoid mechanism. It appears that intravenous administration is more frequently associated with these reactions and occurs at an incidence of 3 per 10 000 doses of intravenous vitamin K1. The solubilizer may also increase the risk of adverse reactions, which occurred in patients with and without previous exposure to vitamin K1. Although there are known factors that increase the risk of an adverse drug event occurring, reactions have been reported despite all precautions being properly followed.

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Section: Discussionmentioning

confidence: 95%

Section: Case Reportsmentioning

confidence: 99%

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Characterizing the Severe Reactions of Parenteral Vitamin K1

Britt

Brown

2016

Clin Appl Thromb Hemost

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“…26 However, the iv route has been associated with the development of anaphylaxis. 27 Alternatively, the oral administration of phytonadione has similar efficacy and safety to iv vitamin K 1. 25,28 Importantly, higher doses of vitamin K 1 are useless, and even harmful, as they can induce resistance to anticoagulation in the postoperative period.…”

Section: ) Indication For Anticoagulationmentioning

confidence: 99%

Perioperative management of patients receiving vitamin K antagonists

Ickx

Steib

2006

Can J Anesth/J Can Anesth

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Purpose: As the number of patients taking vitamin K antagonists (VKA) is growing, the clinician is increasingly faced with having to make decisions regarding anticoagulation therapy before, during and immediately after surgery. In this article we review the indications for VKA and assess their use in the perioperative period based on available pharmacological and clinical data.Source: An on-line computerized search of Medline was conducted limited to English and French language articles. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.Principal findings: Assessment of patients taking VKA who need surgery must include three factors: 1) the indication for anticoagulation, which determines the thromboembolic risk; 2) the pharmacokinetics of VKA, which determine the moment at which treatment should be discontinued; and 3) the type of surgery, which determines the hemorrhagic risk. Some patients will need to stop VKA treatment and start a substitution or "bridging" anticoagulant therapy, such as unfractionated heparin or low molecular weight heparin, prior to and after surgery. In patients requiring emergency surgery, prothrombin complex concentrate can be used to improve coagulation and is preferable to, although more expensive than fresh frozen plasma.

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“…Unfractionated heparin (UFH) or low molecular weight heparins (LMWHs) are indicated in patients at high risk of arterial and/or venous thrombosis, as specified in recent guidelines [3,[5][6][7]. As an oral dose of 1-2.5 mg of vitamin K can efficiently lower INR values after an asymptomatic overdose within 24 h [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], we hypothesized that it might adequately lower the INR in all patients on VKAs scheduled for elective surgery. The primary aim of this study was therefore to investigate whether 1 mg of vitamin K orally on the day before surgery, without VKA interruption, might be as effective in achieving a preoperative INR of £ 1.5 as VKA interruption for 4 days and heparin bridging.…”

Section: Introductionmentioning

confidence: 99%