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Impaired Warfarin Response Secondary to High‐Dose Vitamin K1 for Rapid Anticoagulation Reversal: Case Series and Literature Review
Author(s) -
Fugate Susan E.,
Nichols Carrie M.,
Cudd Laura A.
Publication year - 2004
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.24.13.1213.38080
Subject(s) - warfarin , medicine , vitamin k , series (stratigraphy) , vitamin , atrial fibrillation , biology , paleontology
The literature suggests that unresponsiveness to warfarin can continue for 1 week or longer after administration of high‐dose vitamin K 1 10 mg or greater; however, there is a lack of supporting data to define the duration and clinical consequences of impaired warfarin response with high doses of vitamin K 1 . This case series describes four patients receiving indefinite warfarin therapy who received high and, in most cases, repeated doses of vitamin K 1 for urgent reversal of therapeutic anticoagulation for an invasive procedure or surgery. The patients displayed impaired warfarin response for 11 days–3.5 weeks after administration of vitamin K 1 10–40 mg. The associated financial burden for the patients was substantial. We reviewed the literature to examine the mechanism of impaired warfarin response, and the clinical efficacy, safety, and appropriateness of vitamin K 1 and fresh‐frozen plasma in urgent reversal of anticoagulation.