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Intravenous Vitamin K1 Injections: Dangerous Prophylaxis-Reply

Intravenous Vitamin K1 Injections: Dangerous Prophylaxis-Reply Abstract In reply We appreciate the concerns raised by O'Reilly and Kearns regarding the use of intravenous vitamin K1 in the treatment of patients with warfarin-related excess anticoagulation. As they correctly point out, our article was a synopsis of the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and it recapitulated the guidelines that initially appeared in 1992.1Unfortunately, we do not feel that there is yet adequate information in the scientific literature to unquestionably establish the best route of administration for vitamin K1 in the treatment of excessive warfarin anticoagulation. The approach to patients with excessive anticoagulation must be individualized, and it must take into consideration the ever-delicate balance between hemorrhagic risk and thromboembolic potential as well as other comorbid factors that may influence one's response to vitamin K, especially by the oral route.2,3 It is well known that the occurrence of hemorrhage (that References 1. Third American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):303S-549S.Crossref 2. Hollander D, Rim E, Muralidhara KS. Vitamin K1 intestinal absorption in vivo: influence of luminal contents on transport. Am J Physiol . 1977;232:E69-E74. 3. Barkhan P, Shearer MJ. Metabolism of vitamin K1 (phylloquinone) in man. Proc R Soc Med . 1977;70:93-96. 4. Schepers GP, Dimitry AR, Eckhauser FE, Kirking DM. Efficacy and safety of low dose intravenous versus intramuscular vitamin K in parenteral nutrition patients. J Parenter Nutr . 1988;12:174-177.Crossref 5. Wentzien TH, Kearns PJ, O'Reilly RA. A regression formula for vitamin K reversal in warfarin anticoagulated patients. J Invest Med . 1996;43( (suppl 1) ): 176A. 6. Andersen P, Godal HC. Predictable reduction in anticoagulant activity of warfarin by small amounts of vitamin K. Acta Med Scand . 1975;198:269-270.Crossref 7. Shetty HB, Backhouse G, Bentley DP, et al. Effective reversal of warfarininduced excessive anticoagulation with low dose vitamin K1. Thromb Haemost . 1992;67:13-15. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Intravenous Vitamin K1 Injections: Dangerous Prophylaxis-Reply

Archives of Internal Medicine , Volume 155 (19) – Oct 23, 1995

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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.1995.00430190123018
Publisher site
See Article on Publisher Site

Abstract

Abstract In reply We appreciate the concerns raised by O'Reilly and Kearns regarding the use of intravenous vitamin K1 in the treatment of patients with warfarin-related excess anticoagulation. As they correctly point out, our article was a synopsis of the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy and it recapitulated the guidelines that initially appeared in 1992.1Unfortunately, we do not feel that there is yet adequate information in the scientific literature to unquestionably establish the best route of administration for vitamin K1 in the treatment of excessive warfarin anticoagulation. The approach to patients with excessive anticoagulation must be individualized, and it must take into consideration the ever-delicate balance between hemorrhagic risk and thromboembolic potential as well as other comorbid factors that may influence one's response to vitamin K, especially by the oral route.2,3 It is well known that the occurrence of hemorrhage (that References 1. Third American College of Chest Physicians Consensus Conference on Antithrombotic Therapy. Chest . 1992;102( (suppl) ):303S-549S.Crossref 2. Hollander D, Rim E, Muralidhara KS. Vitamin K1 intestinal absorption in vivo: influence of luminal contents on transport. Am J Physiol . 1977;232:E69-E74. 3. Barkhan P, Shearer MJ. Metabolism of vitamin K1 (phylloquinone) in man. Proc R Soc Med . 1977;70:93-96. 4. Schepers GP, Dimitry AR, Eckhauser FE, Kirking DM. Efficacy and safety of low dose intravenous versus intramuscular vitamin K in parenteral nutrition patients. J Parenter Nutr . 1988;12:174-177.Crossref 5. Wentzien TH, Kearns PJ, O'Reilly RA. A regression formula for vitamin K reversal in warfarin anticoagulated patients. J Invest Med . 1996;43( (suppl 1) ): 176A. 6. Andersen P, Godal HC. Predictable reduction in anticoagulant activity of warfarin by small amounts of vitamin K. Acta Med Scand . 1975;198:269-270.Crossref 7. Shetty HB, Backhouse G, Bentley DP, et al. Effective reversal of warfarininduced excessive anticoagulation with low dose vitamin K1. Thromb Haemost . 1992;67:13-15.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 23, 1995

References