Whitling A M, Bussey H I, Lyons R M
Division of Pharmacotherapy, University of Texas Health Science Center, San Antonio 78284-6220, USA.
Arch Intern Med. 1998 Oct 26;158(19):2136-40. doi: 10.1001/archinte.158.19.2136.
Significant controversy exists concerning how best to reverse excessive anticoagulation (due to warfarin sodium therapy) with phytonadione (vitamin K1) while avoiding overcorrection in patients who need to have anticoagulation therapy maintained.
A retrospective review of phytonadione use in reversing excessive anticoagulation was performed in 3 institutions. The effectiveness of low-dose (< or =0.5 mg) intravenous (LDIV), high-dose (1-10 mg) intravenous (HDIV), subcutaneous (1-10 mg) (SC), and oral (2.5 or 5 mg) (PO) phytonadione was evaluated within 48 hours of administration. Anticoagulation correction (international normalized ratio [INR], > or =2.0 and < or =5.0) occurred in 5 of 8 patients in the LDIV, 5 of 9 in the HDIV, 7 of 10 in the SC, and 5 of 6 in the PO groups. Correction was inadequate (INR >5.0) in 2 of 8 patients in the LDIV, 0 of 9 in the HDIV, 3 of 10 in the SC, and 1 of 6 in the PO groups. Overcorrection (INR <2.0) occurred in 1 patient in the LDIV, 4 patients in the HDIV, 0 in the SC, and 0 in the PO groups.
Anticoagulation correction was achieved in most patients in all 4 groups. The HDIV method was most effective in lowering the INR to less than 5.0, but overcorrection occurred more frequently (4 patients in the HDIV vs 1 patient in the LDIV and 0 patients in the SC and PO groups). Failure to achieve an INR of less than 5.0 was a greater problem in the SC group (3 patients in the SC vs 2 patients in the LDIV and 1 patient in the PO groups). The LDIV and PO methods appear to be acceptable alternatives to the HDIV and SC methods currently recommended.
关于如何最好地使用维生素K1（叶绿醌）逆转过度抗凝（由于华法林钠治疗），同时避免在需要维持抗凝治疗的患者中出现过度纠正，存在重大争议。
在3家机构对使用维生素K1逆转过度抗凝进行了回顾性研究。在给药后48小时内评估低剂量（≤0.5毫克）静脉注射（LDIV）、高剂量（1 - 10毫克）静脉注射（HDIV）、皮下注射（1 - 10毫克）（SC）和口服（2.5或5毫克）（PO）维生素K1的有效性。抗凝纠正（国际标准化比值[INR]，≥2.0且≤5.0）在LDIV组8例患者中有5例，HDIV组9例中有5例，SC组10例中有7例，PO组6例中有5例。纠正不足（INR＞5.0）在LDIV组8例患者中有2例，HDIV组9例中0例，SC组10例中有3例，PO组6例中有1例。过度纠正（INR＜2.0）在LDIV组有1例患者，HDIV组有4例患者，SC组0例，PO组0例。
所有4组中的大多数患者实现了抗凝纠正。HDIV方法在将INR降至低于5.0方面最有效，但过度纠正更频繁发生（HDIV组4例患者，而LDIV组1例患者，SC组和PO组0例患者）。SC组未能使INR低于5.0是一个更大的问题（SC组3例患者，而LDIV组2例患者，PO组1例患者）。LDIV和PO方法似乎是目前推荐的HDIV和SC方法的可接受替代方案。
