This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (12)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Edward N. Libby, MD; David A. Garcia, MD

Arch Intern Med. 2002;162:1893-1896.

Background  Despite published reports of its safety and efficacy, oral vitamin K (phytonadione) may not be widely used for patients with warfarin-associated coagulopathy. We tested the hypothesis that recommendations for phytonadione use from the American College of Chest Physicians (ACCP) Fifth Consensus Conference on Antithrombotic Therapy are not routinely incorporated into the clinical practice of many anticoagulation clinics.

Methods  Surveys were mailed to 100 separate clinics in the southwestern region of the United States that are members of the Anticoagulation Forum, an association of anticoagulation clinic personnel and medical directors in the United States and Canada. Respondents were presented with 4 scenarios involving asymptomatic patients taking warfarin whose international normalized ratio is supratherapeutic. In each scenario, the respondents were told the patient's international normalized ratio and whether the patient was at "high" risk for bleeding.

Results  Of 53 respondents, 13 (25%) indicated that their clinics never use oral phytonadione. Eighteen (34%) indicated that their clinics use subcutaneous phytonadione, despite the absence of a recommendation for this in the ACCP guidelines published in 1998. For each scenario, we made a judgment as to whether the respondent's management was consistent with guidelines found in the ACCP Fifth Consensus Conference on Antithrombotic Therapy. Overall, only 17 respondents (32%) provided all 4 answers consistent with the ACCP recommendations.

Conclusion  For patients with supratherapeutic international normalized ratio values, our survey suggests that a substantial number of anticoagulation clinics underutilize oral phytonadione.

From the General Internal Medicine Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Oral Vitamin K Versus Placebo to Correct Excessive Anticoagulation in Patients Receiving Warfarin: A Randomized Trial
Crowther et al.
ANN INTERN MED 2009;150:293-300.
ABSTRACT | FULL TEXT  

Management of Excessive Anticoagulant Effect Due to Vitamin K Antagonists
Dentali and Crowther
ASH Education Book 2008;2008:266-270.
ABSTRACT | FULL TEXT  

The Risk of Hemorrhage Among Patients With Warfarin-Associated Coagulopathy
Garcia et al.
J Am Coll Cardiol 2006;47:804-808.
ABSTRACT | FULL TEXT  

How Rapidly Do Oncologists Respond to Clinical Trial Data?
Buzdar and Macahilig
The Oncologist 2005;10:15-21.
ABSTRACT | FULL TEXT  

Impact of Clinical Trial Results on National Trends in {alpha}-Blocker Prescribing, 1996-2002
Stafford et al.
JAMA 2004;291:54-62.
ABSTRACT | FULL TEXT