Vitamins
Vitamin K
search
Vitamin K
Indication
Reversal of excessive
Anticoagulation
with
Coumadin
Dosing (See Coumadin Protocol)
Routes: IV, IM, SQ, PO
Oral route is preferred in most cases (consistently absorbed with excellent efficacy)
IV route is indicated in life threatening bleeding or intolerance to oral administration
IV route risks anaphylactic reaction (esp. rapid infusion)
Intramuscular Injection
(of any medication) is not recommended with supratherapeutic INR
Risk of muscle and extremity injury due to localized bleeding
Subcutaneous administration is not recommended due to unpredictable absorption
INR 4 to 10
Give Vitamin K 1-2 mg orally
Dilute parenteral Vitamin K 1-2 mg in flavored drink
Administer Vitamin K 0.5-1 mg IV if not able orally
INR over 10 without bleeding complications
Vitamin K 3 mg SC or slow IV infusion (over 15-30 min)
Check INR at 6 hours
Consider repeating Vitamin K at 6 hours if unchanged
Serious bleeding complication at any elevated INR
Replace
Clotting Factor
s
Vitamin K 10 mg SC or slow IV infusion
Fresh Frozen Plasma
(FFP) 15 ml/kg
Prothrombin Complex Concentrate
(PCC) 50 U/kg
Check INR at 6 hours
Precautions
Anticoagulant
-laced
Synthetic Cannabinoid
s
Drugs contaminated with Brodifacoum rat poison
May require Vitamin K doses as high as 50 mg orally tid for months
Extortionary Vitamin K prices of $50 per 5 mg Vitamin K tab, may cost $45,000 per month
(2018) Presc Lett 25(6):35 [PubMed]
Research
Guideline Studies (See
Coumadin Protocol
)
Consensus Conference (Dalen) advocates giving
Vitamin K SC/IV for INR > 6
Dalen (1995) Chest 108 (sppl):225S-522S (Consensus) [PubMed]
Retrospective study of 51 Arizona Patients with INR >6
No Vitamin K given in 48 patients,
Coumadin
stopped
No adverse outcomes or major bleeding
Glover (1995) Chest 108:987-90 [PubMed]
Oral Vitamin K 1 mg acts faster than subcutaneous
Crowther (2002) Ann Intern Med 137:251-4 [PubMed]
Type your search phrase here