Written by Vivian Lei
In asymptomatic patients with INR>10, vitamin K administration was not associated with improved clinical outcomes.
Why does this matter?
Supratherapeutic warfarin anticoagulation increases risk of bleeding complications, yet data is lacking on how to manage patients who present with an INR > 10 without clinically significant bleeding. Current guidelines recommend administration of vitamin K to this patient population, but this may not be necessary.
Treat the patient, not the number
This was a retrospective cohort study of adult patients on chronic warfarin therapy who had an INR > 10 and had no symptoms of bleeding. Data from 809 patients was included: 41% received vitamin K and 59% did not. In general, patients were elderly with a mean age of 72 and had a high burden of chronic illness. There was no significant difference in the rate of bleeding or thromboembolism at 30 days. The mean time to an INR under 4 was also similar (a little over 2 days). While randomized prospective data is still needed, this is some evidence that asymptomatic patients found to have a high INR may be able to save themselves an extra trip to the ED or the pharmacy.
Vitamin K Versus Warfarin Interruption Alone in Patients Without Bleeding and an International Normalized Ratio > 10. J Thromb Haemost. 2020 May;18(5):1133-1140. doi: 10.1111/jth.14772. Epub 2020 Mar 30.
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