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Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists?
J Thromb Haemost. 2010 Mar; 8(3):499-503.JT

Abstract

BACKGROUND

After a vitamin K antagonist (VKA) overdose, 1-2 mg of oral vitamin K can lower the International Normalized Ratio (INR) to the therapeutic range.

OBJECTIVE

To establish whether oral vitamin K can substitute for heparin bridging and decrease the INR to < or = 1.5 before elective surgery.

METHODS

Patients on long-term VKAs were randomized either to heparin bridging after the last VKA dose on day -5 before surgery (group H) or to VKA treatment until day -2, followed by 1 mg of oral vitamin K on the day before surgery (group K). Blood clotting variables were assessed on days -5/-2, 1 and 0, and postoperatively. If the target INR was not achieved 2 h before incision, surgery was deferred or performed after injection of prothrombin complex concentrate (PCC).

RESULTS

In 30 of 94 included patients, baseline INR was outside the chosen range (18, INR < 2; 12, INR > 3.5), leaving 34 eligible patients in group H and 30 in group K. The groups were balanced in terms of body mass index, VKA treatment duration and indication, scheduled surgery, preoperative and postoperative hemoglobin, and blood loss. The INR was significantly higher in group K on days -1 and 0 than in group H. An INR < or = 1.5 was not achieved in 20 group K patients (66%). Surgery was postponed or performed after PCC injection in 12 of these 20 patients.

CONCLUSIONS

Oral vitamin K (1 mg) cannot substitute for heparin bridging before surgery. In addition, one-third of patients on VKAs were exposed to a risk of bleeding (overdose) or thrombosis (underdose), thus highlighting the need for new oral anticoagulants.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Care, Nouvel Hôpital Civil Strasbourg (University Hospitals), Strasbourg Cedex, France. Annick.Steib@chru-strasbourg.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19912513

Citation

Steib, A, et al. "Can Oral Vitamin K Before Elective Surgery Substitute for Preoperative Heparin Bridging in Patients On Vitamin K Antagonists?" Journal of Thrombosis and Haemostasis : JTH, vol. 8, no. 3, 2010, pp. 499-503.
Steib A, Barre J, Mertes M, et al. Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists? J Thromb Haemost. 2010;8(3):499-503.
Steib, A., Barre, J., Mertes, M., Morel, M. H., Nathan, N., Ozier, Y., Treger, M., & Samama, C. M. (2010). Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists? Journal of Thrombosis and Haemostasis : JTH, 8(3), 499-503. https://doi.org/10.1111/j.1538-7836.2009.03685.x
Steib A, et al. Can Oral Vitamin K Before Elective Surgery Substitute for Preoperative Heparin Bridging in Patients On Vitamin K Antagonists. J Thromb Haemost. 2010;8(3):499-503. PubMed PMID: 19912513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can oral vitamin K before elective surgery substitute for preoperative heparin bridging in patients on vitamin K antagonists? AU - Steib,A, AU - Barre,J, AU - Mertes,M, AU - Morel,M H, AU - Nathan,N, AU - Ozier,Y, AU - Treger,M, AU - Samama,C M, Y1 - 2009/11/12/ PY - 2009/11/17/entrez PY - 2009/11/17/pubmed PY - 2010/7/27/medline SP - 499 EP - 503 JF - Journal of thrombosis and haemostasis : JTH JO - J Thromb Haemost VL - 8 IS - 3 N2 - BACKGROUND: After a vitamin K antagonist (VKA) overdose, 1-2 mg of oral vitamin K can lower the International Normalized Ratio (INR) to the therapeutic range. OBJECTIVE: To establish whether oral vitamin K can substitute for heparin bridging and decrease the INR to < or = 1.5 before elective surgery. METHODS: Patients on long-term VKAs were randomized either to heparin bridging after the last VKA dose on day -5 before surgery (group H) or to VKA treatment until day -2, followed by 1 mg of oral vitamin K on the day before surgery (group K). Blood clotting variables were assessed on days -5/-2, 1 and 0, and postoperatively. If the target INR was not achieved 2 h before incision, surgery was deferred or performed after injection of prothrombin complex concentrate (PCC). RESULTS: In 30 of 94 included patients, baseline INR was outside the chosen range (18, INR < 2; 12, INR > 3.5), leaving 34 eligible patients in group H and 30 in group K. The groups were balanced in terms of body mass index, VKA treatment duration and indication, scheduled surgery, preoperative and postoperative hemoglobin, and blood loss. The INR was significantly higher in group K on days -1 and 0 than in group H. An INR < or = 1.5 was not achieved in 20 group K patients (66%). Surgery was postponed or performed after PCC injection in 12 of these 20 patients. CONCLUSIONS: Oral vitamin K (1 mg) cannot substitute for heparin bridging before surgery. In addition, one-third of patients on VKAs were exposed to a risk of bleeding (overdose) or thrombosis (underdose), thus highlighting the need for new oral anticoagulants. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/19912513/Can_oral_vitamin_K_before_elective_surgery_substitute_for_preoperative_heparin_bridging_in_patients_on_vitamin_K_antagonists L2 - https://doi.org/10.1111/j.1538-7836.2009.03685.x DB - PRIME DP - Unbound Medicine ER -