The Experts below are selected from a list of 81 Experts worldwide ranked by ideXlab platform
Henny H. Billett - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Preoperative Vitamin K on the INR in Bridging Therapy
International Journal of Hematology, 2015Co-Authors: Ashrei Bayewitz, Barbara Scorziello, Clarice Maala, Emily Giannattasio, Henny H. BillettAbstract:We investigated a bridging protocol using oral Vitamin K three days before scheduled surgery. 60 patients in two bridging protocols, 30 cases per protocol. The first cohort (Control Group) had its warfarin held on Day-5 (five days before surgery). The intervention cohort (Vitamin K Group) routinely received 2.5 mg of oral Vitamin K on Day-3 but was otherwise identically bridged. Primary outcome was INR on Day-1. Secondary outcomes included patients with INRs ≥1.5 on Day-1, bleeding episodes and elevated INR post surgery. Day-1 INR for the Vitamin K Group was 1.16, vs. 1.28 for the Control Group ( p = 0.037). Postoperative INR was similar. Only the Control Group had patients with INRs ≥1.5 on Day-1, or patients with significant bleeding. Adding Vitamin K on Day-3 leads to a safe preoperative INR and may limit other complications.
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Effects of Preoperative Vitamin K On the INR in Bridging Therapy
Blood, 2012Co-Authors: Ashrei Bayewitz, Barbara Scorziello, Clarice Maala, Emily Giannattasio, Henny H. BillettAbstract:Abstract 3407 Patients who require interruption of their warfarin therapy before surgery need a safe and effective bridging protocol. Objective: We investigated whether routine incorporation of oral Vitamin K three days before surgery would improve perioperative management. Patients/Methods: Patients on chronic warfarin therapy requiring perioperative bridging therapy were the participants in this observational study. Results from two bridging protocols, 30 cases each, with and without oral Vitamin K, were analyzed. Day of Surgery was considered Day 0. The first cohort (control arm) only received oral Vitamin K preoperatively if their INR was >1.5 on Day -1. The intervention cohort (Vitamin K Group) routinely received 2.5mg of oral Vitamin K on Day -3. Primary outcome was INR on Day -1. Secondary outcomes were number of patients with INRs ≥1.5 on Day -1 or Day 0, number of surgeries delayed, number of postoperative bleeding or thrombotic incidents and INR on Day 4. Results: On Day -1, the INR for the Vitamin K Group was 1.16, compared with 1.28 for the control Group (p=0.037). On re-bridging, Day 4 INR was similar in the two Groups; 1.37 in the Vitamin K Group, and 1.35 in the control Group but there was an increase in the dose needed to achieve these levels for the Vitamin K Group (24.2% over usual dose for the Vitamin K Group vs 7.2% for the control). Only the control Group had patients with INRs ≥1.5 on Day -1 (n=5), INRs ≥1.5 on Day 0 (n=2), or had postoperative bleeding incidents (n=2). Neither Group had delayed surgeries or postoperative thrombosis. Conclusions: Adding Vitamin K on Day -3 into bridging protocols leads to a safe preoperative INR and may limit other complications, but this may come at the expense of increased dosing requirements postoperatively. Disclosures: No relevant conflicts of interest to declare.
Mark A. Crowther - One of the best experts on this subject based on the ideXlab platform.
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Acute Aortic Dissection Presenting With Congestive Heart Failure: Results From the International Registry of Acute Aortic Dissection
2020Co-Authors: Walter Ageno, David Vinuesa García, Mauro Silingardi, Matteo Galli, Mark A. CrowtherAbstract:the primary outcome measure, was initiated. Of the 59 patients, 29 were assigned randomly to 1 mg of oral Vitamin K and 30 were assigned to withhold warfarin only. Baseline characteristics are summarized in Table 1, and results are summarized in Table 2 .N o major bleeding events occurred in either Group. There was one episode of minor bleeding (epistaxis) in the Vitamin K Group and no episodes in the control Group. One patient died in the Vitamin K Group because of acute pulmonary edema; no deaths were recorded in the control Group. This randomized clinical trial is the first to examine the efficacy of oral Vitamin K in patients with mechanical heart valves. Compared with “no treatment,” 1 mg of oral Vitamin K more commonly returned prolonged INR values to the therapeutic or near-therapeutic range within one day. Given that major bleeding can occur in as many as 4% of patients who present with an INR 6.0 who are treated with simple warfarin withdrawal (1), this finding may be clinically relevant. In our study, only 3.4% of patients treated with low-dose oral Vitamin K had INR values 5.0 at 24 h after administration of the study drug. In contrast, 43.3% of the patients who simply withheld warfarin had INR values 5.0 at 24 h after study enrollment (p 0.001). The administration of Vitamin K produced what we defined as an over-reversal in approximately 10% of patients. The difference between the two Groups in the proportion of patients with INR values 1.8 was not statistically significant, and none of the patients in this study had thrombotic events during follow-up. Nevertheless, such a high proportion of patients with an INR less than the therapeutic range raises the concern that low-dose oral Vitamin K may increase the risK of thromboembolism in this population; we anticipate that the results of our ongoing multinational study will determine whether oral Vitamin K, administered in this setting, is associated with thromboembolism. Our study had two important limitations. First, we used the INR, rather than clinical outcomes, as the primary outcome measure. Although the INR is a validated surrogate marKer for bleeding and thrombotic complications in stably anticoagulated patients, its association with these complications is less clear when the INR is changing rapidly (for example, during warfarin initiation or after administration of oral Vitamin K). Second, this study was terminated prematurely, and the enrollment target was not reached. Nonetheless, the observed difference in the primary end point was statistically significant. Even if target enrollment had been reached, it is unliKely that our findings would have had sufficient power either to detect differences in clinical outcomes or to demonstrate a statistically rigorous association between oral Vitamin K administration and an INR 1.8 on day 1. In summary, our study provides additional support for the hypothesis that the administration of 1 mg of oral Vitamin K is very effective for the treatment of asymptomatic warfarin-associated coagulopathy in patients presenting with INR values 6.0. Our enthusiasm for this treatment is, however, tempered by the observation that about one in 10 patients who receive Vitamin K will have an INR of 1.8 on the day following Vitamin K administration; it is possible that these patients are at risK for avoidable thrombosis.
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Low-dose oral Vitamin K to normalize the international normalized ratio prior to surgery in patients who require temporary interruption of warfarin
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Karen Woods, James D. Douketis, Kala Kathirgamanathan, Qilong Yi, Mark A. CrowtherAbstract:BacKground In patients who require warfarin interruption before surgery and have an elevated international normalized ratio (INR) before surgery, low-dose Vitamin K may normalize the INR in time for surgery. Patients and methods In a retrospective cohort study, we assessed the efficacy of 1 mg oral Vitamin K to normalize the INR for surgery and whether resistance to re-anticoagulation occurs when warfarin is restarted after surgery. We studied a cohort of patients with an INR 1.4–1.9 on the day before surgery who received 1 mg oral Vitamin K (Vitamin K Group), and a comparator Group of patients with a normal INR (≤1.3) on the day before surgery who did not receive Vitamin K (no Vitamin K Group). In both patient Groups, we determined the proportion of patients with a normalized INR on the day of surgery and compared the mean INR after surgery when warfarin was resumed. Results Of 43 patients in the Vitamin K Group, the INR was normalized (≤1.3) in 33 patients (76.6; 95% confidence interval [CI]: 64.1–89.4), and the INR was normal or near-normal (≤1.4) in 39 patients (90.7; 95% CI: 82.0–99.4) on the day of surgery. The mean (standard deviation) INR in the Vitamin K and no Vitamin K Group 4–8 days after surgery was 1.75 (0.34) and 1.59 (0.36), respectively ( P = 0.56). Conclusions In patients requiring interruption of warfarin for surgery, 1 mg oral Vitamin K on the day before surgery can normalize the INR by the day of surgery and may not confer resistance to warfarin re-anticoagulation after surgery.
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Low dose oral Vitamin K to reverse acenocoumarol-induced coagulopathy: a randomized controlled trial.
Thrombosis and Haemostasis, 2002Co-Authors: Walter Ageno, Mark A. Crowther, Luigi Steidl, Carolina Ultori, Valentina Mera, Francesco Dentali, Alessandro Squizzato, Chiara Marchesi, Achille VencoAbstract:Low dose oral Vitamin K rapidly reverses warfarin-associated coa-gulopathy. Its effect in patients receiving acenocoumarol is uncertain. We compared the effect of withholding acenocoumarol and administe-ring 1 mg oral Vitamin K with simply withholding acenocoumarol in asymptomatic patients presenting with INR values between 4.5 and 10.0. The primary end-point of the study was the INR value on the day following randomisation. We found that patients receiving oral Vitamin K had more sub-therapeutic INR levels than controls (36.6% and 13.3%, respectively; RR 1.83, 95% confidence interval 1.16, 2.89) and a lower, but non-significant, proportion of INR values in range (50% and 66.6%, respectively) on the day following randomisation. After 5 ± 1 days, there were more patients with an INR value in range in the Vitamin K Group than in controls (74.1% and 44.8%, respecti-vely). There were no clinical events during 1 month follow-up. We con-clude that the omission of a single dose of acenocoumarol is associated with an effective reduction of the INR in asymptomatic patients presenting with an INR value of 4.5 to 10.0. Furthermore, the use of a 1 mg dose of oral Vitamin K results in an excessive risK of over-reversal of the INR.
Ashrei Bayewitz - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Preoperative Vitamin K on the INR in Bridging Therapy
International Journal of Hematology, 2015Co-Authors: Ashrei Bayewitz, Barbara Scorziello, Clarice Maala, Emily Giannattasio, Henny H. BillettAbstract:We investigated a bridging protocol using oral Vitamin K three days before scheduled surgery. 60 patients in two bridging protocols, 30 cases per protocol. The first cohort (Control Group) had its warfarin held on Day-5 (five days before surgery). The intervention cohort (Vitamin K Group) routinely received 2.5 mg of oral Vitamin K on Day-3 but was otherwise identically bridged. Primary outcome was INR on Day-1. Secondary outcomes included patients with INRs ≥1.5 on Day-1, bleeding episodes and elevated INR post surgery. Day-1 INR for the Vitamin K Group was 1.16, vs. 1.28 for the Control Group ( p = 0.037). Postoperative INR was similar. Only the Control Group had patients with INRs ≥1.5 on Day-1, or patients with significant bleeding. Adding Vitamin K on Day-3 leads to a safe preoperative INR and may limit other complications.
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Effects of Preoperative Vitamin K On the INR in Bridging Therapy
Blood, 2012Co-Authors: Ashrei Bayewitz, Barbara Scorziello, Clarice Maala, Emily Giannattasio, Henny H. BillettAbstract:Abstract 3407 Patients who require interruption of their warfarin therapy before surgery need a safe and effective bridging protocol. Objective: We investigated whether routine incorporation of oral Vitamin K three days before surgery would improve perioperative management. Patients/Methods: Patients on chronic warfarin therapy requiring perioperative bridging therapy were the participants in this observational study. Results from two bridging protocols, 30 cases each, with and without oral Vitamin K, were analyzed. Day of Surgery was considered Day 0. The first cohort (control arm) only received oral Vitamin K preoperatively if their INR was >1.5 on Day -1. The intervention cohort (Vitamin K Group) routinely received 2.5mg of oral Vitamin K on Day -3. Primary outcome was INR on Day -1. Secondary outcomes were number of patients with INRs ≥1.5 on Day -1 or Day 0, number of surgeries delayed, number of postoperative bleeding or thrombotic incidents and INR on Day 4. Results: On Day -1, the INR for the Vitamin K Group was 1.16, compared with 1.28 for the control Group (p=0.037). On re-bridging, Day 4 INR was similar in the two Groups; 1.37 in the Vitamin K Group, and 1.35 in the control Group but there was an increase in the dose needed to achieve these levels for the Vitamin K Group (24.2% over usual dose for the Vitamin K Group vs 7.2% for the control). Only the control Group had patients with INRs ≥1.5 on Day -1 (n=5), INRs ≥1.5 on Day 0 (n=2), or had postoperative bleeding incidents (n=2). Neither Group had delayed surgeries or postoperative thrombosis. Conclusions: Adding Vitamin K on Day -3 into bridging protocols leads to a safe preoperative INR and may limit other complications, but this may come at the expense of increased dosing requirements postoperatively. Disclosures: No relevant conflicts of interest to declare.
Zhang Hui-feng - One of the best experts on this subject based on the ideXlab platform.
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Vitamin K Supplementation to Pregnant Women Improved Vitamin K Nutritional Status of their Newborns
China Public Health, 2020Co-Authors: Zhang Hui-fengAbstract:Objective To discuss the effective ways to prevent Vitamin K deficiency bleeding early.Methods By Vitamin K supplementation of pregnant women, to observe whether the Vitamin K status of their newborns can be improved.The pregnant women pregnant for 36-38 weeKs were divided into two Groups randomly: Vitamin K Group and control Group. In the Vitamin K Group, the pregnant women orally taKe Vitamin K1 tablets (5mg/day) till labor. Cord blood samples were assayed for total osteocalcin and undercarboxylated osteocalcin and PIVAK-II.Basing on total osteocalcin and undercarboxylated osteocalcin, the undercarboxylated osteocalcin/ total osteocalcin was calculated.Results Percentages of undercarboxylated osteocalcin in Vitamin K Group were lower than those of control one (13.41%±11.96% to 66.66%±18.20%, P 0.001).In the control Group, the PIVKA-II rate was 26.45%, whereas, in Vitamin K Group, the one drop to zero ( P 0.001).Conclusion Vitamin K supplementation to the pregnant women can improve the Vitamin K status of their newborns.It is an alternative method for prevention of Vitamin K deficiency bleeding.
Karen Woods - One of the best experts on this subject based on the ideXlab platform.
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Low-dose oral Vitamin K to normalize the international normalized ratio prior to surgery in patients who require temporary interruption of warfarin
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Karen Woods, James D. Douketis, Kala Kathirgamanathan, Qilong Yi, Mark A. CrowtherAbstract:BacKground In patients who require warfarin interruption before surgery and have an elevated international normalized ratio (INR) before surgery, low-dose Vitamin K may normalize the INR in time for surgery. Patients and methods In a retrospective cohort study, we assessed the efficacy of 1 mg oral Vitamin K to normalize the INR for surgery and whether resistance to re-anticoagulation occurs when warfarin is restarted after surgery. We studied a cohort of patients with an INR 1.4–1.9 on the day before surgery who received 1 mg oral Vitamin K (Vitamin K Group), and a comparator Group of patients with a normal INR (≤1.3) on the day before surgery who did not receive Vitamin K (no Vitamin K Group). In both patient Groups, we determined the proportion of patients with a normalized INR on the day of surgery and compared the mean INR after surgery when warfarin was resumed. Results Of 43 patients in the Vitamin K Group, the INR was normalized (≤1.3) in 33 patients (76.6; 95% confidence interval [CI]: 64.1–89.4), and the INR was normal or near-normal (≤1.4) in 39 patients (90.7; 95% CI: 82.0–99.4) on the day of surgery. The mean (standard deviation) INR in the Vitamin K and no Vitamin K Group 4–8 days after surgery was 1.75 (0.34) and 1.59 (0.36), respectively ( P = 0.56). Conclusions In patients requiring interruption of warfarin for surgery, 1 mg oral Vitamin K on the day before surgery can normalize the INR by the day of surgery and may not confer resistance to warfarin re-anticoagulation after surgery.
