Kampouraki, Emmanouela;
Avery, Peter J.;
Wynne, Hilary;
Biss, Tina;
Hanley, John;
Talks, Kate;
Kamali, Farhad
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
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Media type:
E-Article
Title:
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
Contributor:
Kampouraki, Emmanouela;
Avery, Peter J.;
Wynne, Hilary;
Biss, Tina;
Hanley, John;
Talks, Kate;
Kamali, Farhad
Published:
Wiley, 2017
Published in:
British Journal of Haematology, 178 (2017) 5, Seite 800-809
Description:
<jats:title>Summary</jats:title><jats:p>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 (<jats:styled-content style="fixed-case">INR</jats:styled-content>) values and response to fixed doses of vitamin K varies. Consequently a significant proportion of patients remain outside their target <jats:styled-content style="fixed-case">INR</jats:styled-content> 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 <jats:styled-content style="fixed-case">INR</jats:styled-content> 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 <jats:styled-content style="fixed-case">INR</jats:styled-content> 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 <jats:styled-content style="fixed-case">INR</jats:styled-content> range compared to the fixed‐dose regimen (68·9% vs. 52·8%; <jats:italic>P</jats:italic> = 0·026), whilst a smaller proportion of patients remained above target <jats:styled-content style="fixed-case">INR</jats:styled-content> range (12·2% vs. 34·0%; <jats:italic>P</jats:italic> < 0·001). Individualised vitamin K dosing is more accurate than fixed‐dose regimen in lowering <jats:styled-content style="fixed-case">INR</jats:styled-content> to within target range in excessively anticoagulated patients.</jats:p>