Treatment of warfarin-associated coagulopathy with vitamin K

Patriquin, Christopher J.; Crowther, Mark

doi:10.1586/ehm.11.59

Cited by 40 publications

(32 citation statements)

References 62 publications

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“…Therefore, an important consideration during warfarin reversal is the route of administration of vitamin K. The preferred routes of administration are intravenous and oral, with the oral route demonstrating a somewhat delayed initial onset of effect compared to intravenous but similar responses by 24 hours [32]. A recent expert review [34] advised against the use of subcutaneous vitamin K because of its unpredictable and suboptimal effect.…”

Section: Discussionmentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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The use of prothrombin complex concentrates (PCCs) and fibrinogen concentrates (FIBCs) to achieve hemostasis in the perioperative setting as alternatives to allogeneic blood products remains controversial. To examine the efficacy and safety of PCCs and FIBCs, we conducted a systematic review-in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement-to compare the use of these transfusion alternatives in bleeding surgical patients. We performed a literature search of English articles published between July 1997 and July 2012 in MEDLINE via PubMed, The Cochrane Library, and CINAHL. Five randomized trials and 15 nonrandomized studies with a comparator group were included in the final review. Studies were sorted into 1 of the following 3 clinical settings: cardiac surgery, non-cardiac surgery, and reversal of warfarin anticoagulation. Risk of bias was assessed using the Cochrane risk of bias tool. With the exception of 2 randomized controlled trials, the existing body of literature on the use of PCCs and FIBCs in the perioperative setting was assessed to have a high degree of methodological bias. Overall, prospective studies in the cardiac surgery grouping suggested that patients receiving FIBC and/or PCCs required less allogeneic blood transfusion and had less chest tube drainage. In studies of warfarin reversal, PCCs more rapidly corrected the International Normalized Ratio compared to plasma; however, in the setting of intracranial hemorrhage, functional outcomes were poor regardless of the reversal strategy. With regards to safety outcomes, reporting was not uniform and raises concerns of underreporting. Adequately powered, methodologically sound trials would be required for more definitive conclusions to be drawn about the efficacy of PCCs and FIBC over conventional blood components for the treatment of perioperative coagulopathy in bleeding patients.

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Section: Discussionmentioning

confidence: 99%

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Lin

Murphy

Tran

2013

Transfusion Medicine Reviews

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“…Following IV infusion of 5-10 mg vitamin K, the INR begins to decrease within 2-4 h and usually reaches a normal range within 24 h [39]. Lower doses may fail to normalize the INR by 24 h, especially in patients with more prolonged INR values, and therefore may be inappropriate in bleeding patients [45,46]. Vitamin K is not ideal for urgently reversing anticoagulation but it provides a sustained correction of the coagulopathy, which lasts beyond that provided by short half-lived FFP and PCC.…”

Section: Treatment Options For Vka Reversalmentioning

confidence: 99%

“…As the response to vitamin K may vary among subjects and warfarin has a much longer duration of action than vitamin K, INR testing every 12 h is advised until the INR stabilizes within normal values. A repeat dose of 5-10 mg may be considered whenever INR values remain elevated [46].…”

Section: Treatment Options For Vka Reversalmentioning

confidence: 99%

Management of anticoagulation in patients with acute gastrointestinal bleeding

Radaelli

Dentali

Repici

et al. 2015

Digestive and Liver Disease

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Acute gastrointestinal bleeding represents the most common adverse event associated with the use of oral anticoagulant therapy. Due to increasing prescription of anticoagulants worldwide, gastroenterologists are more and more called to deal with bleeding patients taking these medications. Their management is challenging because several issues have to be taken into account, such as the severity of bleeding, the intensity of anticoagulation, the patient's thrombotic risk and endoscopy findings. The recent introduction into the marketplace of new direct oral anticoagulants, for whom specific reversal agents are still lacking, further contributes to make the decision-making process even more demanding. Available evidence on this topic is limited and practice guidelines by gastroenterology societies only marginally address key issues for clinicians, including when and how to reverse coagulopathy, the optimal timing of endoscopy and when and how to resume anticoagulation thereafter. The present paper reviews the evidence in the literature and provides practical algorithms to support clinicians in the management of patients on anticoagulants who present with acute gastrointestinal bleeding.

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“…However, high doses of vitamin K1 might induce ''warfarin resistance'' [14], which could influence anticoagulant effect of warfarin even during postoperative period. In our study, it is obvious that the postoperative increase of INR in the vitamin K1 treatment group was significant more slow than other two groups.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant management of pregnant women with mechanical heart valve replacement during perioperative period

Bian

et al. 2015

Arch Gynecol Obstet

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The use of vitamin K1 preoperatively might result in warfarin resistance and discontinuation of warfarin therapy before selective CS might be more appropriate than application of vitamin K1. The "bridging" anticoagulation treatment which combines oral warfarin and subcutaneous LMWH might be more effective and safer than single oral warfarin therapy for patients with mechanical heart valve replacement during postoperative period, no matter selective or emergency CS. The safety of low-dose oral warfarin therapy throughout pregnancy is still under controversy.

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Treatment of warfarin-associated coagulopathy with vitamin K

Cited by 40 publications

References 62 publications

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Use of Prothrombin Complex Concentrates and Fibrinogen Concentrates in the Perioperative Setting: A Systematic Review

Management of anticoagulation in patients with acute gastrointestinal bleeding

Anticoagulant management of pregnant women with mechanical heart valve replacement during perioperative period

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