Medline ® Abstract for Reference 63
of 'Management of warfarin-associated bleeding or supratherapeutic INR'
63
TI
Oral vitamin K lowers the international normalized ratio more rapidly than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy. A randomized, controlled trial.
AU
Crowther MA, Douketis JD, Schnurr T, Steidl L, Mera V, Ultori C, Venco A, Ageno W
SO
Ann Intern Med. 2002;137(4):251.
BACKGROUND:
Excessive anticoagulation due to warfarin use is associated with hemorrhage. Subcutaneously administered vitamin K has not been evaluated for the treatment of warfarin-associated coagulopathy, yet it is widely used.
OBJECTIVE:
To show that oral vitamin K is more effective than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy.
DESIGN:
Randomized, controlled trial.
SETTING:
Two teaching hospitals.
PATIENTS:
Patients with an international normalized ratio (INR) between 4.5 and 10.0.
INTERVENTION:
Warfarin therapy was withheld, and 1 mg of vitamin K was given orally or subcutaneously.
MEASUREMENTS:
The primary outcome measure was the INR on the day after administration of vitamin K. Secondary outcome measures were hemorrhage and thrombosis during a 1-month follow-up period.
RESULTS:
15 of 26 patients receiving oral vitamin K and 6 of 25 patients receiving subcutaneous vitamin K had therapeutic INRs on the day after study drug administration (P = 0.015; odds ratio, 4.32 [95% CI, 1.13 to 17.44]).
CONCLUSION:
Oral vitamin K lowers INR more rapidly than subcutaneous vitamin K in asymptomatic patients who have supratherapeutic INR values while receiving warfarin.
AD
St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. crowthrm@mcmaster.ca
PMID