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Low-dose oral vitamin K to normalize the international normalized ratio prior to surgery in patients who require temporary interruption of warfarin

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Abstract

Background

In patients who require warfarin interruption before surgery and have an elevated international normalized ratio (INR) before surgery, low-dose vitamin K may normalize the INR in time for surgery.

Patients and methods

In a retrospective cohort study, we assessed the efficacy of 1 mg oral vitamin K to normalize the INR for surgery and whether resistance to re-anticoagulation occurs when warfarin is restarted after surgery. We studied a cohort of patients with an INR 1.4–1.9 on the day before surgery who received 1 mg oral vitamin K (vitamin K group), and a comparator group of patients with a normal INR (≤1.3) on the day before surgery who did not receive vitamin K (no vitamin K group). In both patient groups, we determined the proportion of patients with a normalized INR on the day of surgery and compared the mean INR after surgery when warfarin was resumed.

Results

Of 43 patients in the vitamin K group, the INR was normalized (≤1.3) in 33 patients (76.6; 95% confidence interval [CI]: 64.1–89.4), and the INR was normal or near-normal (≤1.4) in 39 patients (90.7; 95% CI: 82.0–99.4) on the day of surgery. The mean (standard deviation) INR in the vitamin K and no vitamin K group 4–8 days after surgery was 1.75 (0.34) and 1.59 (0.36), respectively (P = 0.56).

Conclusions

In patients requiring interruption of warfarin for surgery, 1 mg oral vitamin K on the day before surgery can normalize the INR by the day of surgery and may not confer resistance to warfarin re-anticoagulation after surgery.

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Acknowledgments

The authors express their gratitude to the physicians, nurses and technologists who are part of the Bridging Anticoagulation Clinic at St. Joseph’s Healthcare, Hamilton: Dr. Peter Powers; Dr. Wendy Lim; Ms. Sandra Messier; Ms. Terri Schnurr; and Mrs. Krystyna Kinnon.

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Authors and Affiliations

  1. Department of Medicine, McMaster University and St. Joseph’s Healthcare, Room F-544, 50 Charlton Ave. East, Hamilton, ON, Canada, L8N 4A6

    Karen Woods, James D. Douketis, Kala Kathirgamanathan & Mark A. Crowther

  2. Department of Public Health, University of Toronto, Toronto, ON, Canada

    Qilong Yi

Authors
  1. Karen Woods
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  2. James D. Douketis
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  3. Kala Kathirgamanathan
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  4. Qilong Yi
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  5. Mark A. Crowther
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Corresponding author

Correspondence to James D. Douketis.

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Woods, K., Douketis, J.D., Kathirgamanathan, K. et al. Low-dose oral vitamin K to normalize the international normalized ratio prior to surgery in patients who require temporary interruption of warfarin. J Thromb Thrombolysis 24, 93–97 (2007). https://doi.org/10.1007/s11239-007-0022-z

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  • DOI: https://doi.org/10.1007/s11239-007-0022-z

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