Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases

Denas, Gentian; Marzot, Filippo; Offelli, Pietro; Stendardo, A.; Cucchini, Umberto; Russo, R; Nante, Giovanni; Iliceto, Sabino; Pengo, Vittorio

doi:10.1007/s11239-008-0211-4

Cited by 38 publications

(28 citation statements)

References 38 publications

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“…Previous studies have demonstrated that liver disease may result in a high INR, suggesting that liver dysfunction may affect the first TTA time of warfarin and increase the incidence of excessive anticoagulation (41). The results of the present study demonstrated that the first TTA time was significantly reduced in patients with liver dysfunction, as compared with subjects with normal liver function (P= 0.019), which may increase the INR value; this is consistent with the results of a previous study by Denas et al (42). Furthermore, Abe et al (43)demonstrated that long-term warfarin therapy in patients with end-stage renal disease (ESRD) resulted in a significantly higher binding rate of warfarin and ALB post-hemodialysis, as compared with pre-hemodialysis.…”

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confidence: 92%

Analysis of the first therapeutic-target-achieving time of warfarin therapy and associated factors in patients with pulmonary embolism

Gong

Wang

Yuan

2016

Experimental and Therapeutic Medicine

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Abstract. The present study aimed to investigate the factors affecting the first therapeutic-target-achieving (TTA) time of warfarin therapy in patients with acute pulmonary embolism (PTE). Between January 2008 and June 2013, patients with PTE confirmed by transpulmonary arterial enhanced computed tomographic pulmonary angiography or pulmonary ventilation perfusion scanning were included in the present study. Data collected included demographic information, history of tobacco and alcohol intake, basic diseases (stable and unstable hypertension, diabetes, heart failure, cancer/cerebral infarction, old myocardial infarction and atrial fibrillation), liver and kidney function, the haemoglobin and platelet count of the blood, international normalized ratio monitoring, warfarin dosage adjustment and medication combinations. Dynamic changes in international normalized ratio, anticoagulant efficacy, and adverse events within 90 days were monitored and analyzed. Univariate analysis demonstrated that the following factors affect the first TTA time: Initial dose, body mass index (BMI), liver function, heart failure, and the administration of levofloxacin, cephalosporins, and blood circulation-activating drugs. Logistic regression analysis revealed that the following were independent factors of the first TTA time: Initial dose, BMI, liver function, heart failure and levofloxacin. Therefore, the results of the present study demonstrated that various factors may affect the first TTA time of warfarin therapy, including the initial dose, BMI, liver function, heart function and concomitant medication.

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confidence: 92%

Analysis of the first therapeutic-target-achieving time of warfarin therapy and associated factors in patients with pulmonary embolism

Gong

Wang

Yuan

2016

Experimental and Therapeutic Medicine

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“…Vitamin K may be administered orally or parentally, but parenteral vitamin K has not shown to be better than the oral for INR reversal [75,76]. The use of oral vitamin K has been shown to be safe in reversing the effects of warfarin [77,78]. The use of FFP as a means of reversing warfarin for surgery has been studied less frequently.…”

Section: Anticoagulation Managementmentioning

confidence: 99%

How to optimize patients for geriatric fracture surgery

et al. 2010

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Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high. Multidisciplinary care, including early orthogeriatric input, is recommended to anticipate and treat complications. This article explores modern treatment strategies for this challenging group of patients and provides guidance for systematically preparing and optimizing elderly patients before surgery, based on best available current evidence and recommendations by relevant health organizations.

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“…The administration of vitamin K does not reverse the inhibition of vitamin K oxide reductase, but is a source of reduced vitamin K that allows the carboxylation of the precursor coagulation proteins. The impact of administration of vitamin K on bleeding events and thromboembolism was recently addressed in non-bleeding patients by Crowther et al 26 (INR between 4.5 and 10.0; 1.25 mg oral vitamin K) and Denas et al 27 (INR between 5.0 and 10.0; 2.0 mg oral vitamin K). The data from these studies demonstrated that vitamin K is safe and not associated with an increased frequency of hemorrhagic or thromboembolic events.…”

Section: Withholding Vitamin K Antagonists Treatmentmentioning

confidence: 99%

Emergency management of patients being treated with oral anticoagulants

Manzato

Franchini

2013

Ital J Med

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Vitamin K antagonists (VKA) are among the most widely prescribed drugs in the industrialized world. In fact, for decades, VKA have been the only orally available anticoagulant for the primary and secondary prevention of venous and arterial thrombotic events. Their efficacy has been widely demonstrated in a series of studies carried out in the 1990s. Since the incidences of atrial fibrillation and venous thromboembolism increase exponentially with age, the number of anticoagulated patients is destined to increase. This paper examines anticoagulation therapy management with particular attention to the use of VKA. but also a molecule of O 2 , one of CO 2 , and the reduced form of vitamin K (hydroquinone: KH2) which, in the reaction, is oxidized to vitamin K epoxide. Vitamin K epoxide can be re-used through its reduction first to vitamin K and then to reduced vitamin K by two enzyme systems: the first, vitamin K epoxide reductase, is completely inhibited by dicoumarols, while the second, vitamin K reductase, is only partially inhibited by dicoumarols. 3 The anticoagulant effect of VKA can, therefore, be overcome by even small doses of phytonadione (vitamin K). In Italy, two VKA are available: sodium warfarin (Coumadin) and acenocoumarol (Sintrom). Both are rapidly absorbed through the intestines, with peak blood concentrations being reached after 90 min, and, transported by albumin, accumulate in the liver where they are metabolized. The main difference between the two drugs is their half-lives. Warfarin is a racemic mixture of two isomers: R-warfarin has a halflife of 45 h, while S-warfarin, which is 2.7-3.8 times more potent than R-warfarin, has a half-life of 29 h. Acenocoumarol is also produced as a mixture of two isomers: the half-life of R-acenocoumarol is 9 h, while that of S-acenocoumarol is only 0.5 h. Traditionally, VKA treatment is monitored by measuring the prothrombin time expressed as an INR, which reflects the levels of three clotting factors (II, VII, X) of the four that are vitamin K-dependent. When treatment with VKA is started or suspended, the changes in the prothrombin time/INR reflect the changes in these aforementioned three factors which do, however, have notably different half-lives: 2-9 h for factor VII, 17-44 h for factor X and 60-72 h for factor II. In these situations, the prothrombin time does, therefore, reflect above all the levels of factor VII, while the antithrombotic effect of VKA is correlated with the concentration of factor II. 3Anticoagulant therapy is associated with a risk of bleeding for the entire duration of the treatment, independently of the drug used. Although it would be extremely useful to have clinical prediction parameters for estimating bleeding risk in patients on OAT, unfortunately, none of the available clinical prediction criteria has sufficient predictive accuracy and there have been no trials to evaluate the impact of their use on patients' outcomes. 11 The main variables that influence bleeding are the intensity and duration of the anticoagulation. ...

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Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases

Abstract: This adopted protocol for the reversal of excessive anticoagulation in asymptomatic or minor symptom presenting patients is easily applied, effective in lowering the INR and preventing complications. Its use in high risk thromboembolic patients warrants caution.

Cited by 38 publications

References 38 publications

Analysis of the first therapeutic-target-achieving time of warfarin therapy and associated factors in patients with pulmonary embolism

Analysis of the first therapeutic-target-achieving time of warfarin therapy and associated factors in patients with pulmonary embolism

How to optimize patients for geriatric fracture surgery

Emergency management of patients being treated with oral anticoagulants

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