Efficacy of warfarin reversal in orthopedic trauma surgery patients.
OBJECTIVES: We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery. DESIGN: This was a prospective cohort with immediate prehypothesis consecutive retrospective compa...
| Main Authors: | , , , |
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| Format: | Journal article |
| Language: | English |
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2007
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| _version_ | 1826279991154835456 |
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| author | Tharmarajah, P Pusey, J Keeling, D Willett, K |
| author_facet | Tharmarajah, P Pusey, J Keeling, D Willett, K |
| author_sort | Tharmarajah, P |
| collection | OXFORD |
| description | OBJECTIVES: We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery. DESIGN: This was a prospective cohort with immediate prehypothesis consecutive retrospective comparative case series conducted at a level 1 university hospital trauma unit. PATIENTS: Forty-eight consecutive patients between 1998 and 2004 in a study composed of a prospective cohort were compared with a retrospective consecutive case series of warfarinized orthopedic trauma patients requiring urgent surgery. The prospective arm directly followed the historic case series from which the hypothesis was generated. INTERVENTION: Vitamin K administration. MAIN OUTCOME MEASURES: Primary outcome was time to surgery. Secondary outcomes were problems with active reversal, length of time for warfarin stabilization after surgery, and complications. RESULTS: The mean time to surgery in warfarinized patients not given vitamin K was 111.9 hours; in the intervention group, it was 67.4 hours, giving a mean difference of 44.5 hours (P = 0.01). Vitamin K reduced the international normalized ratio (INR) to less than 2.0 in 74% of patients within 24 hours. There were no complications of vitamin K administration. A dose of vitamin K costs approximately 1/1000 of a hospital bed day cost. A loading dose of warfarin on the second postoperative day took approximately 1 day longer to reach an INR of greater than 2.0 in the intervention patients than in those who had not been given vitamin K. CONCLUSIONS: Warfarin reversal with vitamin K was successful and facilitated earlier surgery in all patients; the first dose was effective in approximately three quarters of patients. It is cost-effective, with no side effects caused in this study. |
| first_indexed | 2024-03-07T00:07:04Z |
| format | Journal article |
| id | oxford-uuid:77e4a648-eb3b-46cb-a757-7a35c676d35b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:07:04Z |
| publishDate | 2007 |
| record_format | dspace |
| spelling | oxford-uuid:77e4a648-eb3b-46cb-a757-7a35c676d35b2022-03-26T20:27:13ZEfficacy of warfarin reversal in orthopedic trauma surgery patients.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:77e4a648-eb3b-46cb-a757-7a35c676d35bEnglishSymplectic Elements at Oxford2007Tharmarajah, PPusey, JKeeling, DWillett, K OBJECTIVES: We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery. DESIGN: This was a prospective cohort with immediate prehypothesis consecutive retrospective comparative case series conducted at a level 1 university hospital trauma unit. PATIENTS: Forty-eight consecutive patients between 1998 and 2004 in a study composed of a prospective cohort were compared with a retrospective consecutive case series of warfarinized orthopedic trauma patients requiring urgent surgery. The prospective arm directly followed the historic case series from which the hypothesis was generated. INTERVENTION: Vitamin K administration. MAIN OUTCOME MEASURES: Primary outcome was time to surgery. Secondary outcomes were problems with active reversal, length of time for warfarin stabilization after surgery, and complications. RESULTS: The mean time to surgery in warfarinized patients not given vitamin K was 111.9 hours; in the intervention group, it was 67.4 hours, giving a mean difference of 44.5 hours (P = 0.01). Vitamin K reduced the international normalized ratio (INR) to less than 2.0 in 74% of patients within 24 hours. There were no complications of vitamin K administration. A dose of vitamin K costs approximately 1/1000 of a hospital bed day cost. A loading dose of warfarin on the second postoperative day took approximately 1 day longer to reach an INR of greater than 2.0 in the intervention patients than in those who had not been given vitamin K. CONCLUSIONS: Warfarin reversal with vitamin K was successful and facilitated earlier surgery in all patients; the first dose was effective in approximately three quarters of patients. It is cost-effective, with no side effects caused in this study. |
| spellingShingle | Tharmarajah, P Pusey, J Keeling, D Willett, K Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title | Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title_full | Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title_fullStr | Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title_full_unstemmed | Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title_short | Efficacy of warfarin reversal in orthopedic trauma surgery patients. |
| title_sort | efficacy of warfarin reversal in orthopedic trauma surgery patients |
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