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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：华法林是一种有效的抗凝剂，但需要密切的国际标准化比率（INR）监测，偶尔可能需要纠正过度的抗凝。目前的指南对非出血门诊患者的超治疗性INR水平≥5.0的维生素K管理提供了有限的实践指导。
目的：根据专家共识和指南，Atrius健康抗凝管理服务(AMS)为高度选择的人群口服维生素K的使用制定了内部指南.本研究将描述口服维生素K使用的内部指导，并介绍相关结果和临床结果。
方法：包括INR>5.0的发作，考虑使用维生素K治疗INR≥6的发作。此外，我们还确定了选择理想的维生素K干预患者的令人信服的适应症和排除。
结果：总体而言，保守治疗；在收集的246次过度抗凝发作中，在18集(7%)中，患者接受维生素K，在228(93%)次发作中，患者未接受维生素K。平均指数INR为6.0（范围5.0-10.5，SD1.07），近57%的发作实现了INR校正，15%的发作实现了INR过度校正。高血栓风险患者，不管出血性风险，接受维生素K的可能性较小。三次发作(1.2%)导致出血并发症。在INR指数≥5.0的30天随访期间，未发生血栓性并发症。
结论：我们的内部指导是一个新颖的，标准化方法，作为决策支持工具，用于使用患者特定特征和指数INR值管理华法林相关凝血病和维生素K干预。本指南可能有助于其他抗凝管理服务的实际应用，并需要在前瞻性临床试验中进行验证。
目的：根据专家共识和指南，Atrius健康抗凝管理服务(AMS)为高度选择的人群口服维生素K的使用制定了内部指南.本研究将描述口服维生素K使用的内部指导，并介绍相关结果和临床结果。
方法：包括INR>5.0的发作，考虑使用维生素K治疗INR≥6的发作。此外，我们还确定了选择理想的维生素K干预患者的令人信服的适应症和排除。
结果：总体而言，保守治疗；在收集的246次过度抗凝发作中，在18集(7%)中，患者接受维生素K，在228(93%)次发作中，患者未接受维生素K。平均指数INR为6.0（范围5.0-10.5，SD1.07），近57%的发作实现了INR校正，15%的发作实现了INR过度校正。高血栓风险患者，不管出血性风险，接受维生素K的可能性较小。三次发作(1.2%)导致出血并发症。在INR指数≥5.0的30天随访期间，未发生血栓性并发症。
结论：我们的内部指导是一个新颖的，标准化方法，作为决策支持工具，用于使用患者特定特征和指数INR值管理华法林相关凝血病和维生素K干预。本指南可能有助于其他抗凝管理服务的实际应用，并需要在前瞻性临床试验中进行验证。
