Comparing Different Routes and Doses of Phytonadione for Reversing Excessive Anticoagulation

Abstract

Background: Significant controversy exists concerning how best to reverse excessive anticoagulation (due to warfarin sodium therapy) with phytonadione (vitamin K 1 ) while avoiding overcorrection in patients who need to have anticoagulation therapy maintained.

American Heart Association/American College of Cardiology Foundation Guide to Warfarin Therapy

“…The response to subcutaneous vitamin K 1 is unpredictable and sometimes delayed. 161,162 In contrast, oral administration is predictably effective and has the advantages of convenience and safety over parenteral routes. In patients with excessively prolonged INR values, vitamin K 1 , 1 mg to 2.5 mg orally, more rapidly lowers the INR to Ͻ5 within 24 hours than simply withholding warfarin.…”

Management of Bleeding in Patients with Advanced Cancer

“…The jury is not out on which route of administration is best. Whitling et al evaluated four different routes of vitamin K administration for reversing excessive anticoagulation: high-dose intravenous (1-10 mg), low-dose intravenous (≤0.5 mg), subcutaneous (1-10 mg), and oral (2.5-5 mg) [71]. Anticoagulation was achieved in all four groups.…”

Low-dose oral vitamin K therapy for the management of asymptomatic patients with elevated international normalized ratios: a brief review

“…Of these 21 studies, 13 were excluded for the following reasons: inclusion of patients with therapeutic INR values, 9 warfarin therapy not suspended, 9,10 vitamin K use in doses greater than 2.5 mg, 11 use of anticoagulants other than warfarin, [12][13][14] published before the development of the INR system, 15 no INR measurement 24 hours following treatment 16 and lack of prospective data collection. [17][18][19][20] One review paper 21 was also excluded because it lacked original data. Eight studies, [22][23][24][25][26][27][28][29] with a total of 344 patients, met all of the inclusion criteria and were included in this review (Tables 2 and 3).…”