Effect of vitamin K administration on rate of warfarin reversal

Abstract

BACKGROUND Vitamin K is reported to begin reversing warfarin within 6 to 12 hours, but this may occur sooner. We sought to determine the rate of international normalized ratio (INR) reversal following vitamin K and relationships with dose, route, and baseline INR. METHODS We evaluated adult patients receiving vitamin K monotherapy for warfarin reversal. Post–vitamin K INRs through 48 hours were collected. Relationships between vitamin K dose and route and baseline INR on rate of reversal and complete reversal (INR < 1.5) were evaluated. Assessment was performed graphically using scatter plots with a line of best fit and a counting process model to determine variables associated with achieving complete reversal. RESULTS A total of 469 post–vitamin K INRs from 235 patients were included. Time to first INR follow‐up after vitamin K administration averaged 10.5 ± 4.2 hours. A significant decrease was detected in INR values in comparison to the baseline INR (3.0 ± 1.9 vs. 4.7 ± 2.2; p < 0.01). Rapid and steady INR change began immediately after vitamin K administration (0–4 hr). A high vitamin K dose and intravenous route were associated with rapid INR change and complete reversal (Vitamin K 10 mg [hazard ratio, 2.4; 95% confidence interval, 1.4–4.2] and IV route [hazard ratio, 1.8; 95% confidence interval, 1.3–2.6]); however, overall complete reversal at 24 and 48 hours was low (14.5% and 41.7%, respectively). Higher baseline INR was associated with rapid INR change and lower baseline INR with complete reversal. CONCLUSION Vitamin K alone starts to reverse warfarin immediately. High vitamin K doses and intravenous route are associated with faster INR reversal. Baseline INR also influences rate of correction and frequency of achieving complete reversal.

Acute Liver Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

“…26 Improvement in INR begins almost immediately after intravenous administration of 1 mg of vitamin K in patients with warfarin toxicity. 27 Clinical HE is an essential component of ALF in adults. Despite difficulty assessing children with HE, particularly younger ones, HE must also be incorporated into the clinical criteria for PALF because its presence and trajectory are associated with outcomes, including liver transplant and death.…”

Recursos ergogênicos nutricionais no esporte: luzes e sombras sobre o seu emprego

“…Podem ainda não ser devidamente absorvidos se não houver estratégias de ingestão que favoreçam sua biodisponibilidade de absorção. Alguns suplementos podem interagir negativamente com alguns medicamentos, como exemplo, a ação da vitamina K na redução da ação anticoagulante da varfarina (derivado cumarínico que atua como antagonista da vitamina K, utilizado na profilaxia e tratamento de diversas doenças tromboembólicas e suas complicações) (Polito et al, 2019); suplementos com dose elevadas de vitaminas C e E podem reduzir a eficácia de algumas categorias de quimioterapia contra o câncer (Burns et al, 2013); o excesso de vitamina A pode causar cefaléia, danos hepáticos e reduzir a resistência óssea (Wang & He, 2020); o excesso de ferro pode causar náuseas e vômitos e danificar órgãos internos, como o fígado e competir com cálcio (Pietrangelo, 2016).…”

Blood Banking and Transfusion Medicine Challenges During the COVID-19 Pandemic

“… 45 , 46 , 47 , 48 Prothrombin complex concentrates and vitamin K may also be effective in warfarin reversal and correcting international normalized ratio. 49 , 50 , 51 Iron supplements, oral or intravenous preparations, and erythropoiesis-stimulating agents are proved to be useful in repleting iron stores and thus increasing hemoglobin levels. 52 PBM and bloodless medicine programs is now a priority throughout national and international health systems ( Fig.…”