Farrow Georgina S, Delate Thomas, McNeil Kelsey, Jones Aubrey E, Witt Daniel M, Crowther Mark A, Clark Nathan P
Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA.
Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA.
J Thromb Haemost. 2020 May;18(5):1133-1140. doi: 10.1111/jth.14772. Epub 2020 Mar 30.
Reversal of an international normalized ratio (INR) > 10 with vitamin K is recommended in patients experiencing bleeding; however, information on outcomes with reversal using vitamin K in non-bleeding patients is lacking.
To compare clinical and safety outcomes between non-bleeding patients receiving warfarin with an INR > 10 who did and did not receive a prescription for vitamin K.
PATIENTS/METHODS: This was a retrospective cohort study conducted in an integrated health-care delivery system. Adult patients receiving warfarin therapy who experienced an INR > 10 without bleeding between 01/01/2006 and 06/30/2018 were included. Patients were assessed for an outpatient dispensing or in-office administration of vitamin K on the day of or the day after an INR > 10 and then clinically relevant bleeding, thromboembolism, all-cause mortality, and time to INR < 4 within the next 30 days.
A total of 809 patients was included with 332 and 477 who were and were not dispensed vitamin K, respectively. Overall, mean patient age was 71.7 years, 60.1% were female and the mean INR was 10.4 at presentation. There were no differences between groups in 30-day rates of bleeding or thromboembolism (both P > .05). Patients dispensed vitamin K had a higher likelihood of mortality (15.1% versus 10.1%, P = .032, adjusted odds ratio = 1.63, 95% confidence interval 1.03 to 2.57). Overall, time to an INR < 4 was similar between groups.
Vitamin K administration was not associated with improved clinical outcomes in asymptomatic patients with an INR > 10.
对于出血患者，推荐使用维生素K逆转国际标准化比值（INR）>10；然而，关于在非出血患者中使用维生素K逆转的结局信息尚缺。
比较国际标准化比值（INR）>10且接受华法林治疗的非出血患者中，接受和未接受维生素K处方者的临床和安全性结局。
患者/方法：这是一项在综合医疗服务系统中开展的回顾性队列研究。纳入2006年1月1日至2018年6月30日期间接受华法林治疗且INR>10但未出血的成年患者。在INR>10当天或之后一天评估患者门诊配药或诊室给予维生素K的情况，然后评估接下来30天内的临床相关出血、血栓栓塞、全因死亡率以及INR降至<4的时间。
共纳入809例患者，分别有332例和477例接受和未接受维生素K配药。总体而言，患者平均年龄为71.7岁，60.1%为女性，就诊时平均INR为10.4。两组在30天出血或血栓栓塞发生率方面无差异（P均>.05）。接受维生素K配药的患者死亡率更高（15.1%对10.1%，P = .032，校正比值比 = 1.63，95%置信区间1.03至2.57）。总体而言，两组INR降至<4的时间相似。
对于INR>10的无症状患者，给予维生素K与改善临床结局无关。
