Crowther Mark A, Wilson Sarah
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Thromb Thrombolysis. 2003 Aug-Oct;16(1-2):69-72. doi: 10.1023/B:THRO.0000014597.87575.e9.
Patients with asymptomatic elevated International Normalized Ratios (INRs) are commonly seen in practice, but there is no consensus on how best to manage this condition. Evidence suggests that low-dose (1 mg to 2.5 mg) oral vitamin K restores patients to INR values associated with a lower risk of hemorrhage more rapidly than discontinuing warfarin alone. Vitamin K therapy remains under-utilized despite evidence for its effectiveness. The studies discussed in this review suggest that vitamin K1 should be considered if rapid reductions in the INR are desired. For most rapid corrections in the INR, vitamin K should be administered by the intravenous route since it begins to reduce the INR within 8 hours. Subcutaneous vitamin K is relatively ineffective, and its use may be associated with over-correction of the INR.
临床上经常会遇到国际标准化比值（INR）无症状升高的患者，但对于如何最佳处理这种情况尚无共识。有证据表明，低剂量（1毫克至2.5毫克）口服维生素K比单独停用华法林能更快地使患者的INR值恢复到与较低出血风险相关的水平。尽管有证据证明维生素K疗法有效，但该疗法仍未得到充分利用。本综述中讨论的研究表明，如果希望快速降低INR，应考虑使用维生素K1。为了使INR得到最快校正，维生素K应通过静脉途径给药，因为它在8小时内就能开始降低INR。皮下注射维生素K相对无效，而且其使用可能与INR过度校正有关。
