title: Treatment of excessive anticoagulation with phytonadione (vitamin K): a meta-analysis.
abstract: BACKGROUND
  Patients taking oral anticoagulants with an international normalized ratio (INR) greater than 4.0 are at increased risk for bleeding. We performed a meta-analysis to determine the effectiveness of phytonadione (vitamin K) in treating excessive anticoagulation.
  
  
  METHODS
  The MEDLINE, EMBASE, and Cochrane Library databases were searched (without language restrictions) for articles published between January 1985 and September 2004. Randomized controlled trials or prospective, nonrandomized trials that used vitamin K to treat patients without major hemorrhage with an INR greater than 4.0 due to oral anticoagulant use were included. The primary outcome was achievement of the target INR (1.8-4.0) at 24 hours after vitamin K administration. Summary estimates were calculated using a random effects model.
  
  
  RESULTS
  Twenty-one studies (10 randomized and 11 prospective trials) were included. Among oral vitamin K treatment arms (4, n = 75), the proportion with a target INR at 24 hours was 82% (95% confidence interval [CI], 70%-93%), which was similar to intravenous vitamin K treatment arms (6, n = 69; target INR, 77%; 95% CI, 60%-95%). Treatment arms of subcutaneous vitamin K (3, n = 58; 31%; 95% CI, 7%-55%) and placebo/observation (2, n = 27; 20%; 95% CI, 0%-47%) were less likely to achieve target INR at 24 hours. Only 1 of 21 trials appropriately assessed for adverse events, so a summary estimate for bleeding risk could not be generated.
  
  
  CONCLUSIONS
  Limited evidence suggests that oral and intravenous vitamin K are equivalent and more effective for excessive anticoagulation than simply withholding warfarin sodium. Subcutaneous vitamin K, however, is inferior to oral and intravenous vitamin K for this indication and is similar to placebo. Whether treatment with vitamin K decreases hemorrhagic events cannot be determined from the published literature.
authors.affiliation: William Beaumont Army Medical Center, El Paso, Tex. 79920-5001, USA. kent.dezee@us.army.mil
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Dezee
authors.forename: William T
authors.initials: WT
authors.lastname: Shimeall
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Douglas
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Shumway
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'malley
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000139:chemically induced / Q000517:prevention & control; D002986:Clinical Trials as Topic; D006801:Humans; D019934:International Normalized Ratio; D010837:Vitamin K 1 / Q000627:therapeutic use*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D014859:Warfarin; D010837:Vitamin K 1