Comparison of the Efficacy and Safety Profiles of Intravenous Vitamin K and Fresh Frozen Plasma as Treatment of Warfarin-Related Over-Anticoagulation in Patients With Mechanical Heart Valves

Patients on warfarin for mechanical heart valves are at increased risk for thromboembolic events and intracranial hemmorhage. In current guidelines, a low dose of vitamin K is the recommended treatment for moderate over-anticoagulation based on studies in which only minority patients participating had mechanical heart valves.We performed a randomized controlled trial to compare the efficacy and safety profile of low-dose intravenous vitamin K and fresh frozen plasma (FFP) for patients with mechanical heart valves and mild to moderate over-anticoagulation (international normalized ratio [INR] 4 to 7). In a 24-month period, we randomized 102 patients to (1) vitamin K or (2) FFP. The baseline INR at presentation between the vitamin K group and the FFP group was 4.61 ± 0.007 vs 4.78 ± 0.07 (p = 0.11). Six hours after treatment, patients in the FFP group had a signficantly lower mean INR compared with the vitamin K group (2.75 ± 0.06 vs 3.44 ± 0.10, p = 0.01). No patient in both groups had over-correction (INR <2). One week later, there was no significant difference in mean INR between both groups (2.7 ± 0.11 vs 2.56 ± 0.12, p = 0.41). Fifty-eight percent of patients in the FFP group and 51% in the vitamin K group had an INR within the target range. There were no adverse reactions or outcomes in both groups. In conclusion, intravenous low-dose vitamin K is a safe alternative to FFP infusion for warfarin overdose in patients with mechanical heart valves.