Subcutaneous phytonadione for reversal of warfarin-induced elevation of the International Normalized Ratio

The efficacy and safety of subcutaneous phytonadione in the treatment of patients with asymptomatic excessive International Normalized Ratio (INR) values secondary to warfarin therapy were evaluated. Patients at an outpatient anticoagulation clinic with an INR of 8 or more but less than 14 were give...

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Bibliographic Details
Published in:American journal of health-system pharmacy 1999-11, Vol.56 (22), p.2312-2315
Main Authors: Byrd, DC, Stephens, MA, Hamann, GL, Dorko, C
Format: Article
Language:English
Subjects:
Adult
Aged
Anticoagulants - adverse effects
Antifibrinolytic Agents - administration & dosage
Biological and medical sciences
Blood Coagulation - drug effects
Blood. Blood coagulation. Reticuloendothelial system
Female
Humans
International Normalized Ratio
Male
Medical sciences
Middle Aged
Outpatients
Pharmacology. Drug treatments
Vitamin K 1 - administration & dosage
Warfarin - adverse effects
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Summary:The efficacy and safety of subcutaneous phytonadione in the treatment of patients with asymptomatic excessive International Normalized Ratio (INR) values secondary to warfarin therapy were evaluated. Patients at an outpatient anticoagulation clinic with an INR of 8 or more but less than 14 were given 1 mg of subcutaneous phytonadione, and patients with an INR of 14 or more but less than 20 received 2 mg. The patients were instructed to withhold warfarin therapy for the next 24 hours and to immediately report any bleeding complications. At subsequent visits, patients with an INR of 8 or more but less than 14 were given an additional 1 mg of subcutaneous phytonadione. Patients with an INR above 4.5 were instructed to withhold warfarin therapy for an additional 24 hours. Seventeen patients received the 1-mg dose (group 1), and four patients received the 2mg dose (group 2). In group 1, the mean INR reduction was 49% at 24 hours and 72% at 48 hours and the INR was below 4.5 in 93% of patients at 48 hours. In group 2, the mean INR reduction was 67% at 24 hours and 85% at 48 hours and the INR was below 4.5 in 100% of patients at 48 hours. In four group-1 patients and one group-2 patient, the INR fell below 2.0 at 48 hours. No patients reported hemorrhagic or thrombotic complications. Subcutaneous phytonadione safely lowered excessively high INR values caused by warfarin therapy.
ISSN:1079-2082
1535-2900
DOI:10.1093/ajhp/56.22.2312