Pharmacology Book

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Vitamin K

Aka: Vitamin K
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  1. Indication
    1. Reversal of excessive Anticoagulation with Coumadin
  2. Dosing (See Coumadin Protocol)
    1. INR 4 to 10
      1. Give Vitamin K 1-2 mg PO
      2. Dilute parenteral Vitamin K 1-2 mg in flavored drink
      3. Administer Vitamin K 0.5-1 mg IV if not able orally
    2. INR over 10 without bleeding complications
      1. Vitamin K 3 mg SC or slow IV infusion
      2. Check INR at 6 hours
      3. Consider repeating Vitamin K at 6 hours if unchanged
    3. Serious bleeding complication at any elevated INR
      1. Replace Clotting Factors
        1. Vitamin K 10 mg SC or slow IV infusion
        2. Fresh Frozen Plasma (FFP) 15 ml/kg
        3. Prothrombin Complex Concentrate (PCC) 50 U/kg
      2. Check INR at 6 hours
  3. Research: Guideline Studies (See Coumadin Protocol)
    1. Consensus Conference (Dalen) advocates giving
      1. Vitamin K SC/IV for INR > 6
      2. Dalen (1995) Chest 108 (sppl):225S-522S (Consensus)
    2. Retrospective study of 51 Arizona Patients with INR >6
      1. No Vitamin K given in 48 patients, Coumadin stopped
      2. No adverse outcomes or major bleeding
      3. Glover (1995) Chest 108:987-90
    3. Oral Vitamin K 1 mg acts faster than subcutaneous
      1. Crowther (2002) Ann Intern Med 137:251-4

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