Mark A. Crowther, MD, MSc; James D. Douketis, MD; Terri Schnurr, RN; Luigi Steidl, MD; Valentina Mera, MD; Carolina Ultori, MD; Achille Venco, MD; Walter Ageno, MD
Excessive anticoagulation due to warfarin use is associated with hemorrhage. Subcutaneously administered vitamin K has not been evaluated for the treatment of warfarin-associated coagulopathy, yet it is widely used.
To show that oral vitamin K is more effective than subcutaneous vitamin K in the treatment of warfarin-associated coagulopathy.
Randomized, controlled trial.
Two teaching hospitals.
Patients with an international normalized ratio (INR) between 4.5 and 10.0.
Warfarin therapy was withheld, and 1 mg of vitamin K was given orally or subcutaneously.
The primary outcome measure was the INR on the day after administration of vitamin K. Secondary outcome measures were hemorrhage and thrombosis during a 1-month follow-up period.
15 of 26 patients receiving oral vitamin K and 6 of 25 patients receiving subcutaneous vitamin K had therapeutic INRs on the day after study drug administration (P = 0.015; odds ratio, 4.32 [95% CI, 1.13 to 17.44]).
Oral vitamin K lowers INR more rapidly than subcutaneous vitamin K in asymptomatic patients who have supratherapeutic INR values while receiving warfarin.
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Crowther MA, Douketis JD, Schnurr T, Steidl L, Mera V, Ultori C, et al. Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy: A Randomized, Controlled Trial. Ann Intern Med. 2002;137:251-254. doi: 10.7326/0003-4819-137-4-200208200-00009
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Published: Ann Intern Med. 2002;137(4):251-254.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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