Correction of Warfarin Coagulopathy for Non-bleeding Patients in the Outpatient Setting at an Ambulatory Care Organization: Application of Vitamin K Guidance.

Aaminah Khan, David DeiCicchi, Peter Collins, Ashwini Ranade, Kathy Zaiken
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Abstract

Background: Warfarin is an effective anticoagulant but requires close International Normalized Ratio (INR) monitoring and may occasionally require correction of excessive anticoagulation. Current guidelines provide limited practical guidance on the administration of vitamin K for the management of supratherapeutic INR levels ≥ 5.0 in non-bleeding outpatients.

Objective: Based on expert consensus and guidelines, the Atrius Health Anticoagulation Management Services (AMS) has developed internal guidance for oral vitamin K use in highly selected populations. This study will describe the internal guidance for oral vitamin K use and present associated results and clinical outcomes.

Methods: Episodes with INR > 5.0 were included, with vitamin K considered for episodes with INR ≥ 6. Moreover, compelling indications and exclusions to select ideal patients for vitamin K intervention were also defined.

Results: Overall, episodes were managed conservatively; of the 246 collected episodes of excessive anticoagulation, in 18 episodes (7%), patients received vitamin K, and in 228 (93%) episodes, patients did not receive vitamin K. The mean index INR was 6.0 (range 5.0 - 10.5, SD 1.07), with nearly 57% of episodes achieving INR correction and 15% of episodes developing INR overcorrection. High thrombotic risk patients, regardless of hemorrhagic risk, were less likely to receive vitamin K. Three episodes (1.2%) resulted in bleeding complications. No thrombotic complications occurred during the 30-day follow-up of the index INR value ≥ 5.0.

Conclusion: Our internal guidance is a novel, standardized approach that serves as a decision support tool for the management of warfarin-associated coagulopathy and vitamin K intervention using patient-specific characteristics and index INR values. This guidance may assist other anticoagulation management services with practical applications and require validation in a prospective clinical trial.

在非住院医疗机构的门诊环境中为非出血患者纠正华法林凝血病:维生素 K 指南的应用。
背景:华法林是一种有效的抗凝剂,但需要密切监测国际标准化比率(INR),偶尔可能需要纠正过度抗凝。目前的指南对非出血门诊患者使用维生素 K 治疗 INR 水平≥ 5.0 的超治疗量提供的实际指导有限:根据专家共识和指南,Atrius Health 抗凝管理服务部(AMS)制定了针对高选择人群口服维生素 K 的内部指南。本研究将介绍口服维生素 K 的内部指南,并展示相关结果和临床疗效:方法:纳入 INR > 5.0 的病例,INR ≥ 6 的病例考虑使用维生素 K。此外,还定义了选择理想患者进行维生素 K 干预的强制性适应症和排除项:在收集到的 246 例过度抗凝事件中,18 例(7%)患者接受了维生素 K 治疗,228 例(93%)患者未接受维生素 K 治疗。INR 平均指数为 6.0(范围为 5.0 - 10.5,SD 为 1.07),近 57% 的事件实现了 INR 矫正,15% 的事件出现 INR 过度矫正。血栓风险高的患者,无论是否有出血风险,接受维生素 K 的可能性都较低。在指数 INR 值≥ 5.0 的 30 天随访期间,没有发生血栓并发症:我们的内部指南是一种新颖的标准化方法,可作为决策支持工具,利用患者特异性特征和指数 INR 值管理华法林相关凝血病和维生素 K 干预。该指南可协助其他抗凝管理服务机构进行实际应用,并需要在前瞻性临床试验中进行验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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