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.
Archives of Internal Medicine – American Medical Association
Published: Oct 23, 1995