Key result
In hospitalized patients with supratherapeutic INR, vitamin K administration showed no statistically significant difference in bleeding events compared to no vitamin K (12% vs 3%; P=0.30).
Why the study?
Does vitamin K administration reduce bleeding events in adult inpatients with supratherapeutic INR between 4.5 and 9?
Observational (n=51)
Does vitamin K administration reduce bleeding events in adult inpatients with supratherapeutic INR between 4.5 and 9?
Absolute Event Rate: 12% vs 3%
p-value: p=0.30
In hospitalized patients with INR 4.5-9, administering vitamin K did not significantly reduce bleeding events, readmission rates, or length of stay, supporting guidelines that recommend against its routine use in the absence of bleeding.
No outcome differences observed with or without vitamin K; leaves open whether guideline-recommended withholding alters bleeding or readmission risk in hospitalized patients.
Background Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. Methods A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K. Records from adult inpatients with at least one INR value between 4.5 and 9 were reviewed. A total of 51 records were evaluated. Thirty-four patients did not receive vitamin K compared to 17 who did. Bleeding events, readmissions rates, length of stay, and familiarity with new guidelines were studied. Results Mean age of patients was 73 years, and 71% were female. No statistically significant differences were observed in bleeding events between patients who received vitamin K and those who did not: 2/17 (12%) and 1/34 (3%), respectively ( P = .30). No differences in 30-day readmission rates (24% vs 18%; P = .71) or in length of stay (7 vs 4 days; P = .11) were found. All pharmacists (13 of 13) were familiar with CHEST 2012 guidelines on the management of supratherapeutic INR compared to 10 of 21 (48%) hospitalists ( P = .001). Conclusions With the national focus on reduction of health care costs, health systems are looking at innovative ways to reduce readmission rates and length of stay. This study, which evaluated the use of vitamin K administration, showed no statistical difference between bleeding events, readmission rates, and length of stay in patients who received vitamin K. Education on the updates of guidelines may be beneficial, as many providers were not familiar with the changes in recommendations.
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Mounce et al. (2015) conducted an observational in Supratherapeutic INR (n=51). Vitamin K vs. No vitamin K was evaluated on Bleeding events (p=0.30). In hospitalized patients with supratherapeutic INR, vitamin K administration showed no statistically significant difference in bleeding events compared to no vitamin K (12% vs 3%; P=0.30).
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