Prospective study of supplemental vitamin K therapy in patients on oral anticoagulants with unstable international normalized ratios

Ford, Sarah K.; Misita, Caron P.; Shilliday, Betsy Bryant; Malone, Robert M.; Moore, Charity G.; Moll, Stephan

doi:10.1007/s11239-007-0014-z

Cited by 38 publications

(42 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some have suggested that taking daily vitamin K could decrease the day-to-day variability of blood vitamin K levels and allow for more predictable warfarin dosing and less time out of therapeutic range [23]. Lastly, a few genetic mutations (CYP2C9*2, CYP2C9*3 and VKORC1) have been associated with altered metabolism of warfarin, and changes in clinical response [24].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation: where we are and where we need to go

Barnes

Froehlich

2008

J Thromb Thrombolysis

View full text Add to dashboard Cite

Although a commonly prescribed medication, warfarin has unique pharmacologic properties that make dosing challenging for many primary care physicians. When a patient's international normalized ratio (INR) is out of the therapeutic range, they are at increased risk for thrombotic or hemorrhagic complications. We have reviewed the current literature for quality improvement techniques to minimize adverse outcomes and improve anticoagulation care. The use of anticoagulation clinics, computer-guided dosing and patient self-monitoring have been demonstrated to reduce adverse events or improve patient and provider satisfaction. Additional techniques, including genetic-based dosing, concurrent vitamin K administration and development of risk-assessment tools, have been discussed, but not fully developed or assessed in the literature. We identify tools that can be implemented today as well as those currently under development for the improvement in anticoagulation care.

show abstract

Section: Introductionmentioning

confidence: 99%

Anticoagulation: where we are and where we need to go

Barnes

Froehlich

2008

J Thromb Thrombolysis

View full text Add to dashboard Cite

show abstract

“…[1,5,17]. For patients like MD, elevated and unstable INR results and challenging warfarin dosing are expected with antiphospholipid syndrome patients [51][52][53][54][55][56][57][58][59][60]. Case reports and one clinical trial have used oral vitamin K doses ranging from 80-500 lg/day [46][47][48][49][50]61].…”

Section: Discussionmentioning

confidence: 99%

Case studies in anticoagulation management

Leong

2007

J Thromb Thrombolysis

View full text Add to dashboard Cite

“…Studies have defined variable INRs as C3 VKA dose changes or C3 INRs outside the therapeutic range within 6 months or an INR standard deviation [0.5 with C3 warfarin dose changes within 6 months [79,80]. In addition to the aforementioned causes of INR variability, patients with variable INRs have been shown to have a lower daily intake of vitamin K than their counterparts with stable INRs [81].…”

Section: Variable Inrsmentioning

confidence: 99%

“…Another proposed approach is low-dose oral vitamin K supplementation in patients with variable INRs. The ideal dose of supplemental vitamin K is not known, but published studies have used 100-500 lg per day [79,81,83]. In a RCT by Sconce et al [80], patients receiving vitamin K achieved a significantly greater increase in percentage TTR (28% ± 20% vs. 15% ± 20%; P \ 0.01).…”

Section: Variable Inrsmentioning

confidence: 99%

Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure

Lee

Crowther

2011

J Thromb Thrombolysis

View full text Add to dashboard Cite

Millions of patients worldwide are prescribed vitamin K antagonists for a variety of medical conditions annually. Despite widespread and long-standing experience with these medications, medical care providers are often confronted with challenging clinical situations. Vitamin K antagonists have a narrow therapeutic index secondary to intrinsic patient characteristics and extrinsic factors including a propensity for drug-drug interactions. Clinicians are required to titrate doses according to the measured international normalized ratio for each individual, balancing the risk of bleeding with preventing thrombosis. The risk of major bleeding associated with vitamin K antagonists has been reported to range from 1 to 3% per year. This narrative review will provide an overview of the most commonly used vitamin K antagonists and discuss the importance of assessing quality of anticoagulation with respect to clinical outcomes. Practical approaches to managing excessive anticoagulation, variable anticoagulation, and anticoagulation failure will be provided, drawing on evidence where applicable and expert opinion where evidence is limited.

show abstract

Prospective study of supplemental vitamin K therapy in patients on oral anticoagulants with unstable international normalized ratios

Abstract: INR fluctuations may decrease in selected patients with unstable INRs who receive vitamin K supplementation. A study with a larger sample size and longer follow-up period is needed. The results of the present study can help design such a study.

Cited by 38 publications

References 5 publications

Anticoagulation: where we are and where we need to go

Anticoagulation: where we are and where we need to go

Case studies in anticoagulation management

Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure

Contact Info

Product

Resources

About