title: Correction of INR by prothrombin complex concentrate and vitamin K in patients with warfarin related hemorrhagic complication.
abstract: We investigated the effect of prothrombin complex concentrate (PCC, median 500 IU) and vitamin K (10-20 mg) or either on blood coagulation and clinical findings in 17 patients with major hemorrhagic complication during warfarin treatment. Their international normalized ratio (INR) at admission was median 2.7 (2.0-above 10.0). In 11 patients treated with PCC and vitamin K, INR decreased to median 1.13 (0.91-1.36) 10 min after the administration with elevation of plasma levels of coagulant factors II, VII, IX, X and protein C.INR decreased abruptly after the administration of PCC without vitamin K in two patients but it increased again 12-24 h after, with decrease of coagulant factors levels. In one of them, a hematoma of the brain enlarged with INR re-increase 12-24 h after the administration. In four patients treated with vitamin K alone, INR decreased slowly from 2.69 (1.03-3.35) to 1.28 (1.25-1.44) 12-24 h after the administration in parallel with gradual increase of the coagulant factors.PCC administration with or without vitamin K seems to be more effective in rapidly correcting increased INR levels than vitamin K treatment without PCC. PCC without vitamin K may result in re-increase of INR and clinical deterioration.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. yasakam@hsp.ncvc.go.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakata
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Naritomi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014812:Vitamin K / Q000008:administration & dosage / Q000627:therapeutic use*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D001779:Blood Coagulation Factors; D014812:Vitamin K; C025667:prothrombin complex concentrates; D014859:Warfarin