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Intravenous Vitamin K1 Injections: Dangerous Prophylaxis

Intravenous Vitamin K1 Injections: Dangerous Prophylaxis Abstract The article on antithrombotic therapy1 that appeared in the January 23, 1995, issue of the Archives was introduced as a synopsis of the proposed guidelines for an American College of Chest Physicians Consensus Conference on Antithrombotic Therapy, including recent updates and information that will likely influence future recommendations. The authors recommend reversing the anticoagulant effects of warfarin when the international normalized ratio is between 6.0 and 10.0 and "the patient is not bleeding," with vitamin K given by slow intravenous injection in a dose of 0.5 to 1.0 mg, and when the international normalized ratio is between 10.0 and 20.0 and "the patient is not bleeding," with a higher dose of vitamin K (3 to 5 mg), also by slow intravenous injection. Their statement that "intravenous vitamin K therapy has been associated with a slightly increased risk of anaphylaxis" is specious at best and deadly at worst. Well over References 1. Becker, RC, Ansell J. Antithrombotic therapy: an abbreviated reference for clinicians. Arch Intern Med . 1995;155:149-161.Crossref 2. Loeliger EA, Broekmans AW. Drugs affecting blood clotting, fibrinolysis, and hemostasis. In: Dukes MNG, ed. Meyler's Side Effects of Drugs: An Encyclopedia of Adverse Reactions and Interactions . 11th ed. Amsterdam, the Netherlands: Elsevier Science Publishers; 1988:735-775. 3. Rich EC, Drage CW. Severe complications of intravenous phytonadione therapy: two cases, with one fatality. Postgrad Med . 1982;72:303-306. 4. Doctors warned on drug. N Y State J Med . 1963;63:2430. 5. Aurstralian Adverse Drug Reactions Committee. Slow down on parenteral vitamin K. Aust Adverse Drug React Bull . 1991;10:3. 6. Reuter HD. Vitamins. In: Aronson JK, Van Boxtel CJ, eds. Side Effects of Drugs Annual 17: A Worldwide Yearly Survey of New Data and Trends . Amsterdam, the Netherlands: Elsevier Science Publishers; 1994:436-444. 7. Shearer MJ, McBurney A, Barkhan P. Studies on the absorption and metabolism of phylloquinone (vitamin K1) in man. Vitam Horm . 1974;32:513-542. 8. Udall JA. Don't use the wrong vitamin K. Calif Med . 1970;112:65-67. 9. Hirsch J, Dalen JE, Deykin D, Poller L. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range: Third American College of Chest Physicians Concensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):312S-326S. 10. Stein PD, Alpert JS, Copeland J, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart vales: Third American College of Chest Physicians Concensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):445S-455S.Crossref 11. Shetty HGM, Backhouse G, Bentley DP, Routledge PA. Effective reversal of warfarin-induced excessive anticoagulation with low dose vitamin K1. Thromb Haemost . 1992;67:13-15. 12. Park BK, Scott AK, Wilson AC, et al. Plasma disposition of vitamin K1 in relation to anticoagulant poisoning. Br J Clin Pharmacol . 1984;18:655-662.Crossref 13. Wentzien TH, Kearns PJ, O'Reilly RA. A regression formula for vitamin K reversal in warfarin anticoagulated patients. J Invest Med . 1995;43( (suppl 1) ): 232A. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Intravenous Vitamin K1 Injections: Dangerous Prophylaxis

Intravenous Vitamin K1 Injections: Dangerous Prophylaxis

Abstract

Abstract The article on antithrombotic therapy1 that appeared in the January 23, 1995, issue of the Archives was introduced as a synopsis of the proposed guidelines for an American College of Chest Physicians Consensus Conference on Antithrombotic Therapy, including recent updates and information that will likely influence future recommendations. The authors recommend reversing the anticoagulant effects of warfarin when the international normalized ratio is between 6.0 and 10.0 and "the...
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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430190123017
Publisher site
See Article on Publisher Site

Abstract

Abstract The article on antithrombotic therapy1 that appeared in the January 23, 1995, issue of the Archives was introduced as a synopsis of the proposed guidelines for an American College of Chest Physicians Consensus Conference on Antithrombotic Therapy, including recent updates and information that will likely influence future recommendations. The authors recommend reversing the anticoagulant effects of warfarin when the international normalized ratio is between 6.0 and 10.0 and "the patient is not bleeding," with vitamin K given by slow intravenous injection in a dose of 0.5 to 1.0 mg, and when the international normalized ratio is between 10.0 and 20.0 and "the patient is not bleeding," with a higher dose of vitamin K (3 to 5 mg), also by slow intravenous injection. Their statement that "intravenous vitamin K therapy has been associated with a slightly increased risk of anaphylaxis" is specious at best and deadly at worst. Well over References 1. Becker, RC, Ansell J. Antithrombotic therapy: an abbreviated reference for clinicians. Arch Intern Med . 1995;155:149-161.Crossref 2. Loeliger EA, Broekmans AW. Drugs affecting blood clotting, fibrinolysis, and hemostasis. In: Dukes MNG, ed. Meyler's Side Effects of Drugs: An Encyclopedia of Adverse Reactions and Interactions . 11th ed. Amsterdam, the Netherlands: Elsevier Science Publishers; 1988:735-775. 3. Rich EC, Drage CW. Severe complications of intravenous phytonadione therapy: two cases, with one fatality. Postgrad Med . 1982;72:303-306. 4. Doctors warned on drug. N Y State J Med . 1963;63:2430. 5. Aurstralian Adverse Drug Reactions Committee. Slow down on parenteral vitamin K. Aust Adverse Drug React Bull . 1991;10:3. 6. Reuter HD. Vitamins. In: Aronson JK, Van Boxtel CJ, eds. Side Effects of Drugs Annual 17: A Worldwide Yearly Survey of New Data and Trends . Amsterdam, the Netherlands: Elsevier Science Publishers; 1994:436-444. 7. Shearer MJ, McBurney A, Barkhan P. Studies on the absorption and metabolism of phylloquinone (vitamin K1) in man. Vitam Horm . 1974;32:513-542. 8. Udall JA. Don't use the wrong vitamin K. Calif Med . 1970;112:65-67. 9. Hirsch J, Dalen JE, Deykin D, Poller L. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range: Third American College of Chest Physicians Concensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):312S-326S. 10. Stein PD, Alpert JS, Copeland J, et al. Antithrombotic therapy in patients with mechanical and biological prosthetic heart vales: Third American College of Chest Physicians Concensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):445S-455S.Crossref 11. Shetty HGM, Backhouse G, Bentley DP, Routledge PA. Effective reversal of warfarin-induced excessive anticoagulation with low dose vitamin K1. Thromb Haemost . 1992;67:13-15. 12. Park BK, Scott AK, Wilson AC, et al. Plasma disposition of vitamin K1 in relation to anticoagulant poisoning. Br J Clin Pharmacol . 1984;18:655-662.Crossref 13. Wentzien TH, Kearns PJ, O'Reilly RA. A regression formula for vitamin K reversal in warfarin anticoagulated patients. J Invest Med . 1995;43( (suppl 1) ): 232A.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 23, 1995

References