Treatment of Excessive Anticoagulation With Phytonadione (Vitamin K): A Meta-analysis

DeZee, Kent J.; Shimeall, William T.; Douglas, Kevin; Shumway, Nathan M.; O’Malley, Patrick G.

doi:10.1001/.391

Cited by 76 publications

(66 citation statements)

References 34 publications

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“…6 Intravenous vitamin K can lower the INR more quickly than oral vitamin K, but at 24 hours, intravenous and oral vitamin K produce similar degrees of INR correction. 7 Subcutaneous vitamin K should not be used because it is less effective than oral or intravenous vitamin K; at 24 hours after treatment with low-dose subcutaneous vitamin K, fewer than 50% of patients will achieve an INR between 1.8 and 4.0.…”

Section: Ase Presentation: a 74-year-old Woman Presents To The Emermentioning

confidence: 97%

Reversal of Warfarin

García

Crowther

2012

Circulation

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Section: Ase Presentation: a 74-year-old Woman Presents To The Emermentioning

confidence: 97%

Reversal of Warfarin

García

Crowther

2012

Circulation

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“…22 While oral, subcutaneous, or IV vitamin K may be administered to correct elevated INRs, the efficacy and associated complications vary for each route. Studies have revealed that oral and IV vitamin K are more effective in their ability to achieve target INR than subcutaneous vitamin K. [24][25][26]46 Furthermore, IV vitamin K provides the most rapid correction of INR, although this route of administration is more frequently associated with overcorrection of INR and is also rarely associated with fatal anaphylaxis. [27][28][29] RiegertJohnson and Volcheck estimated the incidence of anaphylaxis to IV phytonadione to be 3 per 10 000 doses, which is comparable or slightly less than other drugs known to cause anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures

Vitale

VanBeek

Spivack

et al. 2011

Geriatr Orthop Surg Rehabil

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Purpose: Patients with acute hip fractures who are on maintenance warfarin for anticoagulation present a significant challenge and their management remains controversial. The purpose of this study was to assess thromboembolic and systemic complications associated with pharmacological reversal of warfarin-associated coagulopathy in a population of geriatric patients with hip fractures. Methods: This retrospective cohort study identified patients with operative hip fractures on oral warfarin therapy who had an international normalized ratio (INR) >1.50 on admission (N ¼ 93) approximately over a 13-year span. The control group consisted of patients whose warfarin was held upon admission without further intervention preoperatively (n ¼ 23). The treatment group consisted of patients who underwent pharmacologic reversal of elevated INR with vitamin K and/or fresh frozen plasma (FFP) in addition to holding warfarin (n ¼ 70). Primary outcomes included thromboembolic and other complications as well as mortality within 3 months of presentation. Time to surgery was a secondary outcome. Results: The 3-month mortality rate was 4% in the pharmacological intervention group and 17% in the watch-and-wait group; this difference trended toward statistical significance (P ¼ .06). There were no significant differences in the likelihoods of other thromboembolic or nonthromboembolic complications between groups. While the difference in mean time to surgery was not significantly different overall between groups, this difference was significant in a subgroup of patients with higher baseline INRs (n ¼ 46, INR >2.17), with a mean difference of 4.0 fewer days until surgery in the pharmacological intervention group (P < .01). Conclusions: Pharmacological reversal of warfarin-associated coagulopathy with a combination of vitamin K and FFP appears to be a safe way to optimize patients for operative fixation of hip fractures and is associated with a shorter delay to surgery in patients with more elevated INRs preoperatively. Level of evidence: retrospective cohort study (level III).

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“…The subcutaneous and intramuscular route, in addition to its unpredictable onset, leaves an area of induration and is not recommended for reversal of oral VKAs. 22 However, the subcutaneous route is used in neonatalogy and severe liver disease and serves as a vitamin K depot. 6 …”

Section: Monitoringmentioning

confidence: 99%

Reversal of vitamin K antagonists prior to urgent surgery

Grobler

Callum

McCluskey

2010

Can J Anesth/J Can Anesth

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Purpose The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery. Principal findings Vitamin K antagonists, the mainstay in long-term anticoagulation therapy, can be reversed with the administration of vitamin K, frozen plasma (FP), recombinant factor VIIa (rFVIIa), or the recently approved four-factor prothrombin complex concentrate (PCC), OctaplexÒ. While there is little evidence to suggest a superiority of PCC over FP, the availability of PCC in Canada is an important therapeutic addition requiring a thorough understanding of its pharmacology and risk benefit profile for the reversal of vitamin K antagonists. The use of PCC in the management of microvascular bleeding should be limited to very specific indications and should not be indicated in the routine management of massive blood loss. Conclusions In order to limit the blood loss associated with surgery and the management of uncontrolled bleeding, PCC is an important addition to our therapeutic armamentarium in the reversal of vitamin K antagonists.

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Treatment of Excessive Anticoagulation With Phytonadione (Vitamin K): A Meta-analysis

Cited by 76 publications

References 34 publications

Reversal of Warfarin

Reversal of Warfarin

Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures

Reversal of vitamin K antagonists prior to urgent surgery

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