Treatment of excessive anticoagulation with phytonadione (vitamin K): A meta-analysis

Kent J. DeZee*, William T. Shimeall, Kevin M. Douglas, Nathan M. Shumway, Patrick G. O'Malley

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

115 Scopus citations

Abstract

Background: Patients taking oral anticoagulants with an international normalized ratio (INR) greater than 4.0 are at increased risk for bleeding. We performed a meta-analysis to determine the effectiveness of phytonadione (vitamin K) in treating excessive anticoagulation. Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched (without language restrictions) for articles published between January 1985 and September 2004. Randomized controlled trials or prospective, nonrandomized trials that used vitaminKto treat patients without major hemorrhage with an INR greater than 4.0 due to oral anticoagulant use were included. The primary outcome was achievement of the target INR (1.8-4.0) at 24 hours after vitamin K administration. Summary estimates were calculated using a random effects model. Results: Twenty-one studies (10 randomized and 11 prospective trials) were included. Among oral vitamin K treatment-arms (4, n=75), the proportion with a target INR at 24 hours was 82% (95% confidence interval [CI], 70%-93%), which was similar to intravenous vitamin K treatment arms (6, n=69; target INR, 77%; 95% CI, 60%-95%). Treatment arms of subcutaneous vitamin K (3, n = 58; 31%; 95% CI, 7%-55%) and placebo/observation (2, n=27; 20%; 95% CI, 0%-47%) were less likely to achieve target INR at 24 hours. Only 1 of 21 trials appropriately assessed for adverse events, so a summary estimate for bleeding risk could not be generated. Conclusions: Limited evidence suggests that oral and intravenous vitamin K are equivalent and more effective for excessive anticoagulation than simply withholding warfarin sodium. Subcutaneous vitamin K, however, is inferior to oral and intravenous vitamin K for this indication and is similar to placebo. Whether treatment with vitamin K decreases hemorrhagic events cannot be determined from the published literature.

Original languageEnglish
Pages (from-to)391-397
Number of pages7
JournalArchives of Internal Medicine
Volume166
Issue number4
DOIs
StatePublished - 27 Feb 2006
Externally publishedYes

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