 |
|
Comparison of Oral vs Intravenous Phytonadione (Vitamin K1) in Patients With Excessive Anticoagulation
A Prospective Randomized Controlled Study
Aharon Lubetsky, MD;
Hagith Yonath, MD;
David Olchovsky, MD;
Ronen Loebstein, MD;
Hillel Halkin, MD;
David Ezra, MD
Arch Intern Med. 2003;163:2469-2473.
Background Treatment of patients with excessive anticoagulation is routinely done by intravenous phytonadione (vitamin K1). Oral administration of phytonadione has been shown to be an effective alternative to the intravenous route, but these methods have never been compared directly. Our objective was to compare efficacy and safety of intravenous vs oral phytonadione treatment in patients with excessive anticoagulation without bleeding.
Methods The study was a prospective randomized controlled trial of consecutive patients presenting with excessive anticoagulation without major bleeding. Patients with a baseline international normalized ratio (INR) of 6 to 10 (n = 44, 47 episodes) received either intravenous or oral phytonadione (0.5 mg or 2.5 mg, respectively), and patients with an INR greater than 10 (n = 17, 19 episodes) received 1 mg or 5 mg, respectively. Efficacy and safety end points were sequential INR changes and the proportion of patients achieving therapeutic range (INR, 2-4), overcorrection (INR<2.0), or undercorrection (INR>4.0) INR values.
Results Sixty-six episodes of excessive anticoagulation were studied. In patients with baseline INR 6-10 the response to intravenous phytonadione was more rapid than in the oral group, and the proportion of patients reaching therapeutic range INR at 6 hours (11/24 vs 0/23) and at 12 hours (16/24 vs 8/23) was significantly higher. However, mean ± SD INR values were similar for both groups at 24 hours (2.9 ± 0.8 vs 2.6 ± 0.8). Patients in the intravenous group tended to be more often (7/24 vs 2/23) overcorrected (INR<2). In patients with baseline INR values greater than 10 efficacy and safety were comparable for both routes of administration.
Conclusion Oral administration of phytonadione had similar efficacy and safety as intravenously administered phytonadione and may be suitable for treatment of patients with excessive anticoagulation.
From the Department of Medicine, Anticoagulation Clinic (Drs Lubetsky, Yonath, Olchovsky, and Ezra), and the Division of Clinical Pharmacology (Drs Loebstein and Halkin), Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. The authors have no relevant financial interest in this article.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Douketis et al.
Chest 2008;133:299S-339S.
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
Treatment of Excessive Anticoagulation With Phytonadione (Vitamin K): A Meta-analysis.
DeZee et al.
Arch Intern Med 2006;166:391-397.
ABSTRACT
| FULL TEXT
Managing Complications of Anticoagulant Therapy
Smythe et al.
Journal of Pharmacy Practice 2004;17:327-346.
ABSTRACT
Other articles noted: 14 Nov 2003 to 30 Jan 2004
Evid. Based Nurs. 2004;7:e2-e2.
FULL TEXT
Low-dose oral vitamin K therapy for the management of asymptomatic patients with elevated international normalized ratios: a brief review
Wilson et al.
CMAJ 2004;170:821-824.
ABSTRACT
| FULL TEXT
Vitamin K for Excessive Anticoagulation: Oral or IV?
Journal Watch Cardiology 2004;2004:6-6.
FULL TEXT
Oral vs. IV Vitamin K for Reversing Excessive Anticoagulation
JWatch Gastroenterology 2004;2004:8-8.
FULL TEXT
JournalScan
Malik
Heart 2004;90:235-236.
FULL TEXT
Oral vs. IV Vitamin K for Reversing Excessive Anticoagulation
JWatch General 2003;2003:1-1.
FULL TEXT
|
