MINI-DOSE VITAMIN K RESCUE OF THE WARFARIN SENSITIVE PATIENT AVOIDS THE NEED FOR FRESH FROZEN PLASMA IN THE POST-OPERATIVE MANAGEMENT OF TOTAL JOINT ARTHROPLASTY PATIENTS

Participants: A.A. Freiberg, P. Bockenstedt, G.J. Golladay, B. Hallstrom

Keywords: deep vein thrombosis (DVT), warfarin sensitivity, vitamin K, prothrombin time

Introduction

Rapid elevation of the prothrombin time in patients who are sensitive to warfarin used for deep vein thrombosis (DVT) prophylaxis increases the risk of bleeding and hematoma formation. Fresh frozen plasma or large doses of vitamin K have traditionally been used to correct this problem.

Materials and Methods

We report 20 warfarin sensitive patients who were managed with a single mini-dose of oral vitamin K (1 milligram) when the prothrombin time was greater than 20 seconds (INR 2.0).

Results

The PT decreased on average 6.75 seconds (range 2.5 - 11.3) to a mean of 15 seconds (INR 1.5). Three developed post-operative hematomas that did not require operation. There was no excessive wound drainage.

Conclusions

Low dose oral vitamin K decreases the PT to safe levels, avoids exposure to blood products, and does not prevent further anticoagulation