The IP address used for your Internet connection is part of a subnet that has been blocked from access to PubMed Central. Addresses across the entire subnet were used to download content in bulk, in violation of the terms of the PMC Copyright Notice. Use of PMC is free, but must comply with the terms of the Copyright Notice on the PMC site. For additional information, or to request that your IP address be unblocked, For requests to be unblocked, you must include all of the information in the box above in your message.2015 Nov;43(6):712-8.Byrne TJ1, Riedel B1, Ismail HM1, Heriot A1, Dauer R2, Westerman D3, Seymour JF3, Kenchington K1, Burbury K3.Author information1Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria.2Haematology laboratory, Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria.3Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria.AbstractPeriprocedural management of patients on long-term warfarin therapy remains a common and important clinical issue, with little high-quality data to guide this complex process.
The current accepted practice is cessation of warfarin five days preoperatively, but this is not without risk and can be complicated, particularly if bridging is required. An alternative method utilising low-dose intravenous vitamin K the day before surgery has been shown previously to be efficacious, safe and convenient in an elective surgical population receiving chronic warfarin therapy. The efficacy and utility of this 'fast-track' warfarin reversal protocol in surgical patients with cancer, who were at high risk of both thromboembolism and bleeding was investigated in a prospective, single-arm study at a dedicated cancer centre. Seventy-one patients underwent 82 episodes of fast-track warfarin reversal (3 mg intravenous vitamin K 18 to 24 hours before surgery). No patient suffered an adverse reaction to intravenous vitamin K, all but one achieved an International Normalized Ratio =1.5 on the day of surgery, and no surgery was deferred. Assays of vitamin K-dependent factor levels pre- and post-vitamin K demonstrated restoration of functional activity to within an acceptable range for surgical haemostasis.
While this alternative method requires further validation in a larger prospective randomised study, we have now extended our use of fast-track warfarin reversal using vitamin K to patients with cancer, on the basis of our experience of its safety, convenience, reliability and efficacy. warfarinPMID: 26603795 [Indexed for MEDLINE] MeSH termsAdultAgedAged, 80 and overAnticoagulants/pharmacology*Elective Surgical ProceduresFemaleHumansMaleMiddle AgedNeoplasms/surgery*Prospective StudiesVitamin K/adverse effectsVitamin K/therapeutic use*Warfarin/antagonists & inhibitors*SubstancesAnticoagulantsVitamin KWarfarinFull Text SourcesAustralian Society of AnaesthetistsMedicalBlood Thinners - MedlinePlus Health InformationCancer - MedlinePlus Health InformationVitamin K - MedlinePlus Health InformationMiscellaneousWARFARIN - Hazardous Substances Data BankDigital Mammo: Better Ca Detection, But Also More BiopsiesMore HPV Pathology with Single-Dose VaccineFew Teens Treated Well for Opioid AddictionDoctors Mixed on Housecall AppsPodMed: A Medical News Roundup From Johns Hopkins
Vitamin K Speeds Hip Fracture Surgery for Patients on Warfarin Hospital stays shortened by 5 days with rapid warfarin reversal. LAS VEGAS -- Administering vitamin K as a warfarin reversal agent to hip fracture patients shortened time to surgery and improved outcomes, researchers reported here. Compared with a small group of patients who did not undergo vitamin K therapy, patients who received vitamin K went into surgery an average of 1.2 days sooner and spent an average 5.1 fewer days in the hospital, according to Thomas Steven Moores, MBBS, at University Hospitals of North Midlands in Stafford, England. "Testing in the emergency department, and getting the first dose of vitamin K to reverse the warfarin and getting them to theater quicker [improved outcomes]," Moores said in his presentation at the annual meeting of the American Academy of Orthopaedic Surgeons. "But we think bedside testing would improve warfarin reversal times even more." "It's simple and cheap, and as long as it's given slowly, it doesn't give any problems," he added.
In the U.K., 3.2% of roughly 80,000 hip fracture patients a year are on warfarin. Moores and colleagues looked at hip fracture patients who were on warfarin, admitted from 2008 to 2009 (Group 1), and compared them with patients treated from 2010 to 2012 matched by age, gender, fracture type, and Nottingham Hip Fracture Score (Group 2). In 2010, the National Health System in the U.K. instituted a best practices measure for hip fractures, including a financial penalty for not following guidelines, which recommended surgery within 36 to 48 hours of injury. In order to perform surgery within the recommended time frame, patients after 2010 who were on warfarin were treated with 2 mg of IV vitamin K from the time of admission until the international normalized ratio (INR) fell below 1.7. Moores said there aren't any national guidelines on reversal but that the literature suggested that having a reversal protocol had been improving time to surgery. Before the implementation of the 2010 guidelines, it took an average of 13 hours for patients to receive their first dose of vitamin K, and only 36% of patients reached a safe INR within 24 hours of admission.
After 2010, the average time to first dose was 3 hours, and 100% of patients reached a safe INR within 24 hours of admission. In Group 1, there were 41 hip fracture patients, average age 79.7 (SD 7.6), and the ratio of women to men was 3 to 1. In Group 2, there were 48 hip fracture patients, average age 81.2 (SD 8.0), the ratio of women to men was 3 to 1, and all patients were given vitamin K until they reached an INR <1.7 within 24 hours of admission. The average time to surgery was 3.2 days (SD 2.6) for Group 1 and 2.0 days (SD 1.7) for Group 2 (P<0.05). For Group 1, the average length of hospital stay was 16.5 days (SD 13.4), compared with 11.4 days (SD 9.2) for Group 2. On a national scale, prior to 2010, the average length of stay for patients on warfarin was 22.4 days (SD 39.7), and 14.8 days (SD 15) for patients not on warfarin. After 2010, the national average for length of hospital stay was 17.7 days (SD 14.3) for patients on warfarin and 13.2 days (SD 9.5) for patients not on warfarin (P=0.08).