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Correction of Excessive Anticoagulation with Low-Dose Oral Vitamin K₁

Robert T. Weibert, PharmD; Dzung The Le, MD, PhD; Steven R. Kayser, PharmD; and Samuel I. Rapaport, MD

15 June 1997 | Volume 126 Issue 12 | Pages 959-962

Background: Despite earlier acceptance of oral vitamin K₁ (phytonadione) for the treatment of excessive anticoagulation, some recent guidelines do not recommend its use.

Objective: To reevaluate the efficacy of oral vitamin K₁ in correcting excessive anticoagulation.

Design: Case series.

Setting: Anticoagulation clinics at two university medical centers.

Patients: 81 outpatients who had an international normalized ratio (INR) greater than 5.0 but did not have significant bleeding.

Interventions: Withholding 1 or 2 doses of warfarin, administering 2.5 mg of oral vitamin K₁, measuring the INR after 24 to 48 hours, and adjusting the warfarin dose.

Measurements: INRs were obtained from a portable capillary fingerstick monitor or from an automated photooptical coagulometer.

Results: In 68 of 71 patients (96%), oral vitamin K₁ lowered the INR from between 5.0 and 10.0 to less than 5.0 without inducing resistance to further anticoagulation.

Conclusions: Withholding 1 or 2 doses of warfarin and administering 2.5 mg of oral vitamin K₁ is a reliable, safe, and inexpensive way to rapidly correct excessive anticoagulation (INR > 5.0) in patients who do not have serious bleeding episodes and have an INR of less than 10.0.

Author and Article Information

From the University of California, San Diego, California; and the University of California, San Francisco, California.
Grant Support: By grant H27234 from the National Heart, Lung, and Blood Institute, National Institutes of Health.
Requests for Reprints: Robert T. Weibert, PharmD, University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8238.
Current Author Addresses: Dr. Weibert: University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8238.

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