Vittorio Pengo, MD; Gentian Denas, MD; Seena Padayattil Jose, MD
Potential Financial Conflicts of Interest: None disclosed.
Pengo V, Denas G, Jose SP. Vitamin K to Correct Overanticoagulation. Ann Intern Med. 2009;151:433. doi: 10.7326/0003-4819-151-6-200909150-00017
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Published: Ann Intern Med. 2009;151(6):433.
TO THE EDITOR:
We read with interest the study by Crowther and colleagues (1). On the one hand, we appreciated the attempt to create some order in the management of patients who have received excessive anticoagulation, but on the other hand, we are concerned because the authors' conclusions suggest that changing the treatment policy used in many thrombosis centers in Italy is needed. Since the publication of our first work in the field (2), we usually give oral vitamin K to patients without bleeding events whose INR is greater than 5.0. In a recent retrospective study (3), we reported 1043 events of overanticoagulation (INR, 5.0 to 10.0) occurring over 10 years that were treated with oral vitamin K, 2 mg. This approach was associated with a very low incidence of bleeding: Only 1 major bleeding event (secondary to intervention) occurred during 30 days of follow-up (0.1% [95% CI, <0.01% to 0.60%]). Our protocol differs from that used by Crowther and colleagues in that we based the vitamin K dose on slightly different levels of overanticoagulation, used a different pharmaceutical form of the administered drug (in solution), and administered the drug promptly at the time of INR determination. Despite treatment, 10% of the patients were still overanticoagulated the next day. Our results make us hesitant to change our policy according to Crowther and colleagues' conclusions. Data from the concurrent trial being conducted by Crowther and colleagues (in patients with INRs >10.0) may clarify the potential value of vitamin K in treating patients with overanticoagulation. It will be interesting to compare these results with those from an analogue study we conducted (4) on 105 patients, which showed that oral vitamin K, 3 mg, is safe, with no major bleeding events reported during 30 days.
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