Preprocedure Administration of Oral Vitamin K1: Lessons Learned from 2 Experiences in the Same Patient

摘要: INTRODUCTION The management of patients undergoing invasive procedures while taking oral anticoagulant therapy can be complex and requires careful evaluation several risk factors, including the urgency surgery, thrombosis in absence warfarin, procedure-related bleeding. Lowering international normalized ratio (INR) before an procedure may involve following steps: withholding warfarin for about 4 days procedure,1 administering vitamin K1 (phytonadione) either orally or intravenously 24–48 h procedure,1-3 infusing fresh frozen plasma clotting factor concentrate with life-threatening bleeding urgent need surgery.3,4 For ambulatory patients, by administration is commonly used to rapidly reduce critical INR values (defined as above 5.0) therapeutic (2.0–3.5).1 Small doses (1.0–2.5 mg) are suggested if between 5.0 9.0, whereas 5–10 mg recommended 10.0 above.1 IV also efficacious this indication, but use route outpatients limited, because drug must administered slowly. completely reverse a preparation elective not routine, our knowledge has been reported. We proposed that might number preprocedure over which patient would require subtherapeutic anticoagulation. Current practice periprocedural who receiving have range 2.0–3.0 discontinue 5 then reintroduce it after procedure.1 Patients at greater thromboembolism often given “bridging therapy” heparin anticoagulation temporarily reversed.1 In elevated (above 3.0) longer period recommended5,6; implies, high thromboembolic event, extended when full-dose low-molecular-weight (LMWH) administered.2 describe (INR 3.5–4.0) was treated each 2 procedures. Despite abundant literature evaluating management, first report normalize on basis procedure.