The purpose of this study is to demonstrate the safety and efficacy of Vitamin K when administered as an ultra-slow intravenous drip (IVPB) in comparison to standard acute INR reversal utilizing fresh frozen plasma (FFP).
A chart review of 44 patients was performed. Patients were treated with PO, SQ, IV Push (IVP), IVPB, and IM Vitamin K for reversal of elevated INR at the attending physician’s discretion. IVPB was administered at 1mg Vitamin K in 50-100cc of 0.9% NaCl solution over 2-4 hours. Acute INR reversal is defined as correction within 24 hours. Several patients were also treated with FFP after given Vitamin K. Initial INR, reversed INR, time to reversal, method of reversal, and complications were recorded. Our results were reviewed in conjunction with established clinical data utilizing IV vitamin K therapy.
There were 22 (50%) males and 22 (50%) females in our study. Vitamin K was administered as an IVPB in 16 (36.4%) patients, IVP in 2 (4.5%), IM in 2 (4.5%), PO/SQ in 24 (54.5%). Eleven (25.0%) patients also received FFP. Of those, 1 had received an initial IVPB drip of Vitamin K, 10 had received either SQ, PO, or SQ/PO doses of Vitamin K. There were no complications from Vitamin K administration irrespective of the route. Preliminary findings show, IVPB administration reversed the INR within 14h43m (±12h22m), IVP 12h13m (±5h43m), IM 29h11m (±22h39m), PO/SQ 35h50m (±14h22m). Patients who received FFP had INR reversal within 16h03m (±13h06m). Additionally, average costs for INR reversal with IM, IVP, IVPB, SQ/PO, and FFP were $8.00, $4.10, $5.23, $6.72, and $251.85, respectively.
IVPB Vitamin K administration is a safe, effective and economically sound method of acute INR reversal. IVPB is superior to the standard agent of FFP for acute reversal of elevated INR.
Based upon our results, a further study should be developed to consider the initial treatment of choice for acute reversal of elevated INR.
Murtaza Dawood, None.