Randomized, Placebo‐Controlled Trial of Oral Phytonadione for Excessive Anticoagulation

Abstract

The addition of oral phytonadione 2.5 mg reduced the time to achieve an INR of 4.0 by approximately 1 day compared with omitting warfarin therapy alone. Adverse events did not differ between the two groups. Both strategies were effective in managing asymptomatic patients with INRs of 6.0-10.0. Oral phytonadione may be most appropriate for patients at high risk for bleeding in whom the benefit of prompt INR reduction would outweigh the thromboembolic risk associated with INR overcorrection.

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…red. ), by INR z poziomu między 6,0 i 10,0 zmniejszył się do 4,0 [258]. Acenokumarol wykazuje krótki okres półtrwania, a czas potrzebny do efektywnego obniżenia INR może wynosić mniej niż 1 dzień u większości pacjentów.…”

Management of Bleeding in Patients with Advanced Cancer

“…A randomized, double-blind, placebo-controlled study comparing oral phytonadione (2.5 mg) plus the omission of further warfarin therapy with omission alone for reversing excessive warfarin anticoagulation in 30 asymptomatic patients (INR levels of [6][7][8][9][10] found that the addition of oral phytonadione reduced the time to achieve a normal INR by 1 day [77]. Adverse effects did not differ between the two groups.…”

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

“…[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). We used these articles to answer 4 questions, which are addressed below.…”

“…[22][23][24][25] Two double-blind, placebo-controlled RCTs demonstrated that oral vitamin K therapy reduces the INR more promptly than does the withholding of warfarin alone. 22,23 Despite the evidence that oral vitamin K therapy is effective, chart reviews and physician surveys have shown that physicians prefer to administer vitamin K subcutaneously. [30][31][32] This preference exists despite evidence from randomized trials that the subcutaneous route is less effective than either the oral 24 or intravenous route.…”

“…However, studies that restricted enrolment to patients with INRs below 10 tended to have a greater proportion of patients with therapeutic INRs at 24 hours [22][23][24][25][26][27] than did studies without such restrictions 28,29 (Tables 2 and 3). This evidence suggests that the use of low-dose oral vitamin K therapy should be confined to patients with INRs below 10.…”