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

被引:12
作者
Byrd, DC
Stephens, MA
Hamann, GL
Dorko, C
机构
[1] Univ Alabama, Coll Community Hlth Sci, Dept Family Med, Tuscaloosa, AL 35401 USA
[2] Auburn Univ, Sch Pharm, Dept Pharm Practice, Auburn, AL 36849 USA
[3] Reg Med Ctr, Dept Clin Pharm, Memphis, TN USA
[4] Univ Tennessee, Dept Internal Med, Coll Med, Memphis, TN 38163 USA
关键词
anticoagulants; dosage; phytonadione; toxicity; vitamins; warfarin;
D O I
10.1093/ajhp/56.22.2312
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
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. Patient 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 I 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 l-mg dose (group I), and four patients received the 2-mg 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 MR values caused by walfarin therapy.
引用
收藏
页码:2312 / 2315
页数:4
相关论文
共 17 条
  • [1] Low-dose vitamin K therapy in excessively anticoagulated patients: A dose-finding study
    Brophy M.T.
    Fiore L.D.
    Deykin D.
    [J]. Journal of Thrombosis and Thrombolysis, 1997, 4 (2) : 289 - 292
  • [2] Crowther MA, 1998, THROMB HAEMOSTASIS, V79, P1116
  • [3] Antagonism of warfarin-induced hypoprothrombinemia with use of low-dose subcutaneous vitamin K-1
    Fetrow, CW
    Overlock, T
    Leff, L
    [J]. JOURNAL OF CLINICAL PHARMACOLOGY, 1997, 37 (08) : 751 - 757
  • [4] CONSERVATIVE TREATMENT OF OVERANTICOAGULATED PATIENTS
    GLOVER, JJ
    MORRILL, GB
    [J]. CHEST, 1995, 108 (04) : 987 - 990
  • [5] Mechanism of action, clinical effectiveness, and optimal therapeutic range
    Hirsh, J
    Dalen, JE
    Anderson, DR
    Poller, L
    Bussey, H
    Ansell, J
    Deykin, D
    Brandt, JT
    [J]. CHEST, 1998, 114 (05) : 445S - 469S
  • [6] HIRSH J, 1995, CHEST S, V108, P231
  • [7] HIRSH J, 1992, CHEST S, V102, P312
  • [8] LANDEFELD CS, 1989, AM J MED, V87, P153
  • [9] LEVINE MN, 1995, CHEST S, V108, P276
  • [10] Evaluation of excessive anticoagulation in a group model health maintenance organization
    Lousberg, TR
    Witt, DM
    Beall, DG
    Carter, BL
    Malone, DC
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1998, 158 (05) : 528 - 534