Question

Tsu LV, Dienes JE, Dager WE. Vitamin K dosing to reverse warfarin based on INR, route of administration, and home warfarin dose in the acute/critical care setting. Ann Pharmacother. 2012; 46:1617-26.

Answer 1

Subsequent INR readings are influenced by the dose, method, and initial INR of vitamin K. For intravenous vitamin K doses of 2 mg or more, INR decrease is comparable. FFP preadministration has no effect on INR readings 48 hours or more after vitamin K administration.

What is Abstract of Vitamin K dosing to reverse warfarin based on INR, route of administration, and home warfarin dose in the acute/critical care setting?

• Commonly, vitamin K is used to reverse the anticoagulant effects of warfarin. The ideal vitamin K dosage and delivery method that does not lengthen bridging therapy are still unclear.
• To ascertain the elements affecting the level and pace of vitamin K-induced INR reversal in the acute/critical care setting.
• 400 patients' charts from between February 2008 and November 2010 who got vitamin K to counteract the effects of warfarin were examined. International normalized ratios (INRs), intravenous or oral vitamin K doses, and whether or not fresh frozen plasma (FFP) was administered were among the information gathered. INRs were measured 12, 24, and 48 hours before vitamin K treatment.
• At baseline, 12 hours, 24 hours, and 48 hours, respectively, intravenous vitamin K decreased INR more quickly than oral vitamin K (5.09, 1.91, 1.54, and 1.41 vs. 5.67, 2.90, 2.14, and 1.58). Subsequent INR values were impacted by baseline INR (p 0.001), method of administration (p 0.001), and vitamin K dosage (p 0.001). For intravenous vitamin K doses of 2 mg or more, there was a similar drop in INR. Home warfarin dose had no effect on INR responses to intravenous or oral vitamin K (p = 0.98 and 0.27, respectively). FFP had no effect on INR readings 48 hours later. Although larger vitamin K doses and longer anticoagulation bridge therapy appeared to be related, neither the incidence (p = 0.63) nor the duration (p = 0.61) were statistically significant.

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