Vitamin K Dosing to Reverse Warfarin Based on INR, Route of Administration, and Home Warfarin Dose in the Acute/Critical Care Setting

Author:

Tsu Laura V1,Dienes J Erin2,Dager William E3

Affiliation:

1. Pharmacy Practice, Midwestern College of Pharmacy Glendale, Glendale, AZ

2. University of California Davis Medical Center, Sacramento, CA

3. UC Davis Medical Center, UC San Francisco School of Pharmacy, UC Davis School of Medicine, Touro School of Pharmacy, Sacramento

Abstract

Background: Vitamin K is commonly used for reversal of anticoagulation of warfarin. However, the optimal dose and route of vitamin K that does not increase the duration of bridging therapy is unknown. Objective: To determine factors influencing the extent and rate of INR reversal with vitamin K in the acute/critical care setting. Methods: This was a chart review of 400 patients who received vitamin K for reversal of warfarin effects between February 2008 and November 2010. Data collected included international normalized ratios (INRs) 12 hours, 24 hours, and 48 hours prior to vitamin K administration; intravenous or oral vitamin K dose; and whether or not fresh frozen plasma (FFP) was administered. Results: Intravenous vitamin K reduced INR more rapidly than oral vitamin K (5.09, 1.91, 1.54, and 1.41 vs 5.67, 2.90, 2.14, and 1.58) at baseline, 12, 24, and 48 hours, respectively. The dose of vitamin K (p < 0.001), route of administration (p < 0.001), and baseline INR (p < 0.001) influenced subsequent INR values. The INR reduction was similar for intravenous vitamin K doses 2 mg or greater. Home warfarin dose did not affect INR responses to intravenous (p = 0.27) or oral vitamin K (p = 0.98). FFP did not influence INR values at 48 hours. Although longer anticoagulation bridge therapy seemed to be associated with higher vitamin K doses, the incidence (p = 0.63) and duration (p = 0.61) were not significant. Conclusions: Vitamin K dose, route, and initial INR influence subsequent INR values. INR reduction is similar for intravenous vitamin K doses of 2 mg or greater. Preadministration of FFP does not alter INR values at 48 hours or more after vitamin K administration.

Publisher

SAGE Publications

Subject

Pharmacology (medical)

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