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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

Lookup NU author(s): Emma Kampouraki, Dr Peter Avery, Dr Hilary Wynne, Dr Tina Biss, Dr John Hanley, Dr Katherine Talks, Professor Farhad Kamali

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Blackwell Publishing Ltd, 2017.

For re-use rights please refer to the publisher's terms and conditions.


Abstract

© 2017 John Wiley & Sons Ltd 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 (INR) values and response to fixed doses of vitamin K varies. Consequently a significant proportion of patients remain outside their target INR 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 INR 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 INR 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 INR range compared to the fixed-dose regimen (68·9% vs. 52·8%; P = 0·026), whilst a smaller proportion of patients remained above target INR range (12·2% vs. 34·0%; P < 0·001). Individualised vitamin K dosing is more accurate than fixed-dose regimen in lowering INR to within target range in excessively anticoagulated patients.


Publication metadata

Author(s): Kampouraki E, Avery PJ, Wynne H, Biss T, Hanley J, Talks K, Kamali F

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2017

Volume: 178

Issue: 5

Pages: 800-809

Print publication date: 01/09/2017

Online publication date: 02/08/2017

Acceptance date: 29/03/2017

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: Blackwell Publishing Ltd

URL: https://doi.org/10.1111/bjh.14777

DOI: 10.1111/bjh.14777


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