No Vitamin K for non-bleeding INR

In this multicenter randomized controlled trial of nonbleeding patients with INR levels between 4.5-10, they were randomized to placebo or vitamin K 1.25mg orally. At 90 days, there was no difference between the groups in bleeding (each 16%), or thromboembolism (1%), although the INR did decrease faster in the vitamin K group (1.4 in placebo versus 2.8 in vitmain K, in the 1st day) (abstract). This is fairly consistent with the current ACCP guidelines, which suggest omitting 1-2 doses of warfarin for INR levels 5-9 (with vitamin K reserved for patients at high risk of bleeding) (guidelines).

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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