Khan Aaminah, DeiCicchi David, Collins Peter, Ranade Ashwini, Zaiken Kathy
Inpatient Department of Pharmacy Services, Harbor-UCLA Medical Center, Torrance, CA, USA.
Anticoagulation Management Service, Clinical Pharmacy, Atrius Health, Watertown, MA, USA.
Cardiovasc Hematol Agents Med Chem. 2025;23(1):58-68. doi: 10.2174/0118715257286369240527055010.
Warfarin is an effective anticoagulant but requires close International Normalized Ratio (INR) monitoring and may occasionally require correction of excessive anticoagulation. Current guidelines provide limited practical guidance on the administration of vitamin K for the management of supratherapeutic INR levels ≥ 5.0 in non-bleeding outpatients.
Based on expert consensus and guidelines, the Atrius Health Anticoagulation Management Services (AMS) has developed internal guidance for oral vitamin K use in highly selected populations. This study will describe the internal guidance for oral vitamin K use and present associated results and clinical outcomes.
Episodes with INR > 5.0 were included, with vitamin K considered for episodes with INR ≥ 6. Moreover, compelling indications and exclusions to select ideal patients for vitamin K intervention were also defined.
Overall, episodes were managed conservatively; of the 246 collected episodes of excessive anticoagulation, in 18 episodes (7%), patients received vitamin K, and in 228 (93%) episodes, patients did not receive vitamin K. The mean index INR was 6.0 (range 5.0 - 10.5, SD 1.07), with nearly 57% of episodes achieving INR correction and 15% of episodes developing INR overcorrection. High thrombotic risk patients, regardless of hemorrhagic risk, were less likely to receive vitamin K. Three episodes (1.2%) resulted in bleeding complications. No thrombotic complications occurred during the 30-day follow-up of the index INR value ≥ 5.0.
Our internal guidance is a novel, standardized approach that serves as a decision support tool for the management of warfarin-associated coagulopathy and vitamin K intervention using patient-specific characteristics and index INR values. This guidance may assist other anticoagulation management services with practical applications and require validation in a prospective clinical trial.
华法林是一种有效的抗凝剂，但需要密切监测国际标准化比值（INR），且偶尔需要纠正过度抗凝。目前的指南对于非出血性门诊患者INR水平≥5.0的超治疗范围时维生素K的使用管理提供的实用指导有限。
基于专家共识和指南，阿提勒斯健康抗凝管理服务（AMS）针对高度特定人群制定了口服维生素K使用的内部指南。本研究将描述口服维生素K使用的内部指南，并呈现相关结果和临床结局。
纳入INR>5.0的病例，对于INR≥6的病例考虑使用维生素K。此外，还定义了选择维生素K干预理想患者的强制指征和排除标准。
总体而言，病例采用保守管理；在收集的246例过度抗凝病例中，18例（7%）患者接受了维生素K，228例（93%）患者未接受维生素K。平均初始INR为6.0（范围5.0 - 10.5，标准差1.07），近57%的病例INR得到纠正，15%的病例INR出现过度纠正。高血栓形成风险患者，无论出血风险如何，接受维生素K的可能性较小。3例（1.2%）出现出血并发症。在初始INR值≥5.0的30天随访期间未发生血栓形成并发症。
我们的内部指南是一种新颖、标准化的方法，可作为使用患者特定特征和初始INR值管理华法林相关凝血病和维生素K干预的决策支持工具。该指南可能有助于其他抗凝管理服务的实际应用，且需要在前瞻性临床试验中进行验证。
