Vitamin K to Correct Overanticoagulation

Mark W. Swaim; B. Gail Macik

doi:10.7326/0003-4819-151-6-200909150-00016

Letters |15 September 2009

Vitamin K to Correct Overanticoagulation

Mark W. Swaim, MD, PhD; B. Gail Macik

Article, Author, and Disclosure Information

Potential Financial Conflicts of Interest: None disclosed.

TO THE EDITOR:

In their recent study on managing supratherapeutic warfarin administration with or without vitamin K, Crowther and colleagues (1) use flawed methodology to arrive at what may be an apocryphal conclusion, which is that vitamin K therapy has no role in managing patients with high international normalized ratios (INRs).

The study uses a commercially unavailable vitamin K preparation. The pharmacokinetics and effectiveness of this preparation have not been clinically validated.

Confronted with overanticoagulation, clinicians explore recent relevant events; exclude patient dosing errors; consider vitamin K; and most important, modify doses of warfarin. Crowther and colleagues attempt to control for dose adjustment by simply blinding us to it. We are given no specific parameters used by practitioners in the trial with regard to warfarin dosing. We are thus asked to accept the conclusions of a trial whose methodology has an element of nihilism.

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Letters |15 September 2009

Vitamin K to Correct Overanticoagulation

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Letters |15 September 2009

Vitamin K to Correct Overanticoagulation

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