Department of Pharmacy, University of Rochester Medical Center, Rochester, NewYork.
Department of Emergency Medicine, University of Rochester, Rochester, NewYork.
Transfusion. 2019 Apr;59(4):1202-1208. doi: 10.1111/trf.15146. Epub 2019 Feb 4.
Vitamin K is reported to begin reversing warfarin within 6 to 12 hours, but this may occur sooner. We sought to determine the rate of international normalized ratio (INR) reversal following vitamin K and relationships with dose, route, and baseline INR.
We evaluated adult patients receiving vitamin K monotherapy for warfarin reversal. Post-vitamin K INRs through 48 hours were collected. Relationships between vitamin K dose and route and baseline INR on rate of reversal and complete reversal (INR < 1.5) were evaluated. Assessment was performed graphically using scatter plots with a line of best fit and a counting process model to determine variables associated with achieving complete reversal.
A total of 469 post-vitamin K INRs from 235 patients were included. Time to first INR follow-up after vitamin K administration averaged 10.5 ± 4.2 hours. A significant decrease was detected in INR values in comparison to the baseline INR (3.0 ± 1.9 vs. 4.7 ± 2.2; p < 0.01). Rapid and steady INR change began immediately after vitamin K administration (0-4 hr). A high vitamin K dose and intravenous route were associated with rapid INR change and complete reversal (Vitamin K 10 mg [hazard ratio, 2.4; 95% confidence interval, 1.4-4.2] and IV route [hazard ratio, 1.8; 95% confidence interval, 1.3-2.6]); however, overall complete reversal at 24 and 48 hours was low (14.5% and 41.7%, respectively). Higher baseline INR was associated with rapid INR change and lower baseline INR with complete reversal.
Vitamin K alone starts to reverse warfarin immediately. High vitamin K doses and intravenous route are associated with faster INR reversal. Baseline INR also influences rate of correction and frequency of achieving complete reversal.
据报道，维生素 K 可在 6 至 12 小时内开始逆转华法林的作用，但这可能更早发生。我们旨在确定维生素 K 治疗后国际标准化比值（INR）的逆转率及其与剂量、途径和基线 INR 的关系。
我们评估了接受维生素 K 单药治疗以逆转华法林的成年患者。收集了维生素 K 治疗后 48 小时内的 INR 值。评估了维生素 K 剂量和途径与基线 INR 之间的关系，以及这些因素与逆转率和完全逆转（INR<1.5）的关系。通过散点图和最佳拟合线以及计数过程模型进行评估，以确定与完全逆转相关的变量。
共纳入了 235 例患者的 469 次维生素 K 治疗后 INR 值。维生素 K 给药后首次 INR 随访的平均时间为 10.5±4.2 小时。与基线 INR（3.0±1.9 比 4.7±2.2；p<0.01）相比，INR 值显著下降。在维生素 K 给药后立即出现快速而稳定的 INR 变化（0-4 小时）。高维生素 K 剂量和静脉途径与 INR 的快速变化和完全逆转相关（维生素 K 10mg [风险比，2.4；95%置信区间，1.4-4.2]和静脉途径 [风险比，1.8；95%置信区间，1.3-2.6]）；然而，24 小时和 48 小时时的总体完全逆转率较低（分别为 14.5%和 41.7%）。较高的基线 INR 与 INR 的快速变化相关，而较低的基线 INR 与完全逆转相关。
单独使用维生素 K 即可立即开始逆转华法林。高剂量维生素 K 和静脉途径与 INR 更快逆转相关。基线 INR 也会影响校正速度和达到完全逆转的频率。
