Prospective study of supplemental vitamin K therapy in patients on oral anticoagulants with unstable international normalized ratios

Abstract

Background

It is not known whether patients on oral vitamin K antagonists who have unstable INRs achieve more stable INRs with daily vitamin K supplementation. We sought to determine whether vitamin K supplementation may decrease INR variability in patients with a history of unstable INRs, how soon the INR decreases after vitamin K therapy is initiated, the time to reach a therapeutic INR after vitamin K initiation, and how much of an increase in oral anticoagulant dose is needed to maintain the INR in the desired range.

Methods

This is a prospective open label crossover study of patients on warfarin with a history of fluctuating INRs. A 9 week observation phase was followed by an 8 week period with patients receiving 500 μg of oral vitamin K daily. INRs were determined once weekly with a home point of care monitoring instrument.

Results

Vitamin K supplementation led to a decrease in INR variability in five of the nine patients studied (56%). INR decrease occurred 2–7 days after initiation of vitamin K. Therapeutic INRs were achieved 2–35 days after vitamin K therapy was initiated and an increase in warfarin dose of 6–95% was required to bring the INR back into the therapeutic range.

Conclusions

INR fluctuations may decrease in selected patients with unstable INRs who receive vitamin K supplementation. A study with a larger sample size and longer follow-up period is needed. The results of the present study can help design such a study.