Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy

  title={Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy},
  author={Mark Andrew Crowther and James D Douketis and Terri Schnurr and Luigi Steidl and Valentina Mera and Carolina Ultori and Achille Venco and Walter Ageno},
  journal={Annals of Internal Medicine},
Context Giving vitamin K when stopping warfarin increases the rate at which the international normalized ratio (INR) returns to normal. Although many clinicians give vitamin K subcutaneously, it appears that oral vitamin K reduces INR more rapidly. Contribution This randomized, controlled trial compared oral with subcutaneous vitamin K for patients receiving warfarin who had an INR of 4.5 to 10.0 but no bleeding. Oral administration normalized the INR faster than the subcutaneous route… 
Oral Vitamin K Versus Placebo to Correct Excessive Anticoagulation in Patients Receiving Warfarin
The hypothesis that bleeding events would be reduced was based on the previously published, smaller studies of low-dose oral vitamin K administered to various patient groups, and it was found that a consistent and rapid decrease in the INR after low- dose vitamin K was administered.
Low-dose oral vitamin K therapy for the management of asymptomatic patients with elevated international normalized ratios: a brief review
Evidence from randomized controlled trials supports the use of low-dose oral vitamin K therapy as a treatment that promptly reduces the INR, and suggests that this occurs infrequently when small doses are administered orally.
Vitamin K for the Treatment of Asymptomatic Coagulopathy Associated with Oral Anticoagulant Therapy
Evidence suggests that low-dose oral vitamin K restores patients to INR values associated with a lower risk of hemorrhage more rapidly than discontinuing warfarin alone, and vitamin K1 should be considered if rapid reductions in the INR are desired.
Treatment of warfarin-associated coagulopathy with vitamin K
Despite development of new oral anticoagulant therapy compounds, warfarin will probably retain a prominent role in thromboembolism management for several years to come.
Management of excessive anticoagulant effect due to vitamin K antagonists.
The evidence supporting various treatment modalities and suggestions for treatment are reviewed and future advances in this area will likely focus on evaluations of the relative merits of FFP and PCCs.
Appraisal of current vitamin K dosing algorithms for the reversal of over‐anticoagulation with warfarin: the need for a more tailored dosing regimen
There is a need for a more individualized approach to the reversal of over‐anticoagulation in asymptomatic or mildly haemorrhagic patients in order to improve the safety of warfarin therapy.
Use of Oral Vitamin K1 by Patients Taking Warfarin Sodium: Experience in an Ambulatory Care Clinic
For ambulatory patients taking warfarin sodium, oral vitamin K1 can be used to reduce a high INR value without the need for a clinic visit.
Management of an Unintentional Warfarin Overdose With Oral Vitamin K in the Outpatient Setting Prior to Elevation of the International Normalized Ratio
This case describes a 64-year-old patient during the warfarin dose titration phase of her anticoagulation therapy that confuses the physical appearance of her tablets, resulting in awarfarin overdose, and oral vitamin K was administered to prevent the anticipated international normalized ratio rise that would be predicted.
Warfarin induced coagulopathy in children: assessment of a conservative approach
Withholding warfarin alone for management of non-bleeding INRs ≥5 and ≤8 appears to be safe and effective.
Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure
An overview of the most commonly used vitamin K antagonists is provided and the importance of assessing quality of anticoagulation with respect to clinical outcomes is discussed, drawing on evidence where applicable and expert opinion where evidence is limited.


Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomised controlled trial
Low-dose oral vitamin K reliably reverses over-anticoagulation due to warfarin.
In patients receiving warfarin who have asymptomatic excessive prolongations in their INR results, 1 mg of oral vitamin K reliably reduces the INR to the therapeutic range within 24 h, suggesting this therapy is more convenient, less expensive, and might be safer than parenteral vitamin K.
Reversal of excessive effect of regular anticoagulation: low oral dose of phytonadione (vitamin K1) compared with warfarin discontinuation.
It is suggested that a low oral dose of vitamin K1 is a convenient treatment for excessive anticoagulation in patients with no bleeding complications.
Time course of reversal of anticoagulant effect of warfarin by intravenous and subcutaneous phytonadione.
For patients who are excessively anticoagulated with warfarin, small doses of SC phytonadione may not correct the INR as rapidly or as effectively as when administered IV.
Prospective study of the outcomes of ambulatory patients with excessive warfarin anticoagulation.
Outpatients with INRs greater than 6.0 face a significant short-term risk of major hemorrhage and Randomized trials are needed to determine the net benefit of preventive treatment with phytonadione.
Treatment of warfarin-associated coagulopathy: a physician survey.
Physician preferences for the reversal of warfarin-induced excessive AC were highly variable and, in most cases, did not follow the recommendations of the ACCP consensus guidelines, highlighting the need for randomized controlled trials to compare the efficacy of different routes of administration of vitamin K for warfar in-associated coagulopathy.
Conservative treatment of overanticoagulated patients.
This trial showed that conservative treatment of nonbleeding overanticoagulated patients is safe, and a prospective trial comparing the ACCP guidelines with a conservative approach is needed.
Randomized, Placebo‐Controlled Trial of Oral Phytonadione for Excessive Anticoagulation
Study Objective. To compare the efficacy of managing excessive anticoagulation in the absence of bleeding by either omitting warfarin therapy alone or administering oral phytonadione in addition to