Clinical experience with oral versus intravenous vitamin K for warfarin reversal (CME)

BACKGROUND: Reversal of warfarin with plasma accounts for a large amount of fresh‐frozen plasma transfused in the United States. The use of vitamin K is an alternate strategy. STUDY DESIGN AND METHODS: Records of vitamin K prescriptions for warfarin reversal were examined and recipients identified where data were available on dosage, route of administration (oral [PO] and intravenous [IV]) and the availability of both pre‐ and postadministration international normalized ratio(s) (INRs). RESULTS: A total of 135 administration events were evaluated: 81 PO and 54 IV. The median (range) preadministration INRs were 5.8 (1.9‐16.5) versus 5.0 (1.4‐16.5; p = 0.61) and the median (range) for the postadministration INRs were 2.4 (1.0‐10.4) and 2.1 (1.2‐8.2; p < 0.01) for the PO and IV routes, respectively. The median (range) doses were 2.5 (1‐10) and 2.0 (1‐10) mg for PO and IV, respectively (p < 0.01). A total of 44% of the IV vitamin K group achieved an INR of 2 or less within 12 hours versus 14% for the PO route (p < 0.01). In multilinear regression the preadministration INR (r = 0.14, p < 0.01) and time after administration (r = −0.05, p < 0.01) were independent variables influencing the postadministration INR but the dose administered (r = 0.09, p = 0.07) was not. CONCLUSION: Vitamin K needs to be given IV if urgent partial correction (<12 hr) of warfarin is required. No influence of dose administered in the range 1 to 10 mg on the postadministration INR was observed.