Editorial: Warfarin reversal: Schism between clinical practice and published guidelines

摘要

In the study, the reason behind vitamin K administration was split somewhat equally between bleeding, urgent procedure, and ST-INR. A higher portion of the bleeding group received IV vitamin K while a higher portion of the ST-INR group received oral; patients needing correction for an urgent procedure showed no difference in route administered. The preference for IV in bleeding patients is in line with guidelines, but almost one-third of bleeding patients received oral vitamin K despite needing emergent reversal. Additionally, patients presenting with gastrointestinal bleeding may not adequately absorb oral vitamin K, so these patients especially could benefit from IV administration. The number of red blood cell units transfused in bleeding patients on IV versus oral was not statistically different. The time between baseline ST-INR results and administration of vitamin K therapy (lag time) was surprisingly long at medians of 5.5 and 22 hours at the upper limit. The study also showed that the dosage of vitamin K used did not affect posttreatment INR. Posttreatment INR was only affected by pretreatment INR and total duration of vitamin K therapy before testing.