Assessment of the efficacy of a novel tailored vitamin K dosing regimen in lowering the International Normalised Ratio in over-anticoagulated patients: a randomised clinical trial
- Resource Type
- Authors
- Kate Talks; Peter Avery; Tina Biss; Farhad Kamali; John Hanley; Hilary Wynne; Emmanouela Kampouraki
- Source
- British Journal of Haematology. 178:800-809
- Subject
- Adult
Male
Vitamin
medicine.medical_specialty
Vitamin K
Administration, Oral
Hemorrhage
030204 cardiovascular system & hematology
Asymptomatic
Drug Administration Schedule
Young Adult
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Oral administration
Thromboembolism
Internal medicine
medicine
Humans
International Normalized Ratio
Dosing
Blood Coagulation
Aged
Aged, 80 and over
Body surface area
Dose-Response Relationship, Drug
business.industry
Warfarin
Anticoagulants
Hematology
Middle Aged
Antifibrinolytic Agents
Clinical trial
Regimen
Treatment Outcome
chemistry
030220 oncology & carcinogenesis
Physical therapy
Female
medicine.symptom
business
medicine.drug
- Language
- ISSN
- 0007-1048
Summary Current guidelines advocate using fixed-doses of oral vitamin K to reverse excessive anticoagulation in warfarinised patients who are either asymptomatic or have minor bleeds. Over-anticoagulated patients present with a wide range of International Normalised Ratio (INR) values and response to fixed doses of vitamin K varies. Consequently a significant proportion of patients remain outside their target INR after vitamin K administration, making them prone to either haemorrhage or thromboembolism. We compared the performance of a novel tailored vitamin K dosing regimen to that of a fixed-dose regimen with the primary measure being the proportion of over-anticoagulated patients returning to their target INR within 24 h. One hundred and eighty-one patients with an index INR > 6·0 (asymptomatic or with minor bleeding) were randomly allocated to receive oral administration of either a tailored dose (based upon index INR and body surface area) or a fixed-dose (1 or 2 mg) of vitamin K. A greater proportion of patients treated with the tailored dose returned to within target INR range compared to the fixed-dose regimen (68·9% vs. 52·8%; P = 0·026), whilst a smaller proportion of patients remained above target INR range (12·2% vs. 34·0%; P