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Prospective Evaluation of Anticoagulant Reversal With Oral Vitamin K1 While Continuing Warfarin Therapy Unchanged

Thomas H. Wentzien; Robert A. O'Reilly; Patrick J. Kearns
Author and Funding Information

Affiliations: From the Departments of Medicine, Santa Clara Valley Medical Center, San Jose, CA,  From the Departments of Medicine, Santa Clara Valley Medical Center, San Jose, CA; and the Stanford University School of Medicine, Stanford, CA.

Patrick J. Kearns, MD, 751 S. Bascom Avenue, San Jose, CA 95128; e-mail: pj.kearns@med.stanford.EDU


1998 by the American College of Chest Physicians


Chest. 1998;114(6):1546-1550. doi:10.1378/chest.114.6.1546
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Published online

Abstract

Study objectives: To study the efficacy and safety of partially correcting therapeutic anticoagulation by administering oral vitamin K1.

Design: Prospective interventional trial.

Setting: Outpatient anticoagulation clinic.

Patients: Patients who required reversal of their normal or excessive therapy with oral anticoagulant drugs were recruited.

Interventions: All patients received a single oral dose of vitamin K1. The dose was calculated using a regression formula and was intended to decrease the international normalized ratio (INR) to a predetermined value. Patient follow-up continued for 8 weeks. We compared the actual change of the INR to the predicted change.

Results: Sixty-five reversals of anticoagulant therapy were initiated in the study group. Sixty-four of the 65 reversals were successful. The mean (± SEM) initial INR was 2.6 ± 0.1 for the preprocedure patients and 8.4 ± 0.5 for the excessively anticoagulated patients. The predicted change in the INR correlated with the actual change (r = 0.92, p < 0.0001). There were no thromboembolic events and only one hemorrhagic complication. The mean (± SEM) dose of oral vitamin K1 was 5.0 ± 0.3 mg for the preprocedure patients and 10.0 ± 1.0 mg for the excessively anticoagulated patients.

Conclusions: The administration of a single oral dose of vitamin K1 is a safe and effective method for partially reversing anticoagulant therapy without disrupting the daily maintenance dose of warfarin. A reliable regression formula was developed to predict the dose of vitamin K1 needed to achieve the desired INR.


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