Efficacy And Safety of Low-dose Intravenous Vitamin K For International Normalized Ratio Reversal In Left Ventricular Assist Device Patients

Introduction Left ventricular assist device (LVAD) patients require warfarin, a vitamin K antagonist, as an anticoagulant to prevent thromboembolic events. LVAD patients that present with bleeding requiring a non-emergent procedure (ie. endoscopy) often require an international normalized ratio (INR) Hypothesis Low-dose IV vitamin K ( Methods We conducted a single-center, retrospective cohort analysis comparing low-dose IV vitamin K to “watchful waiting” in 100 LVAD patients. Baseline characteristics such as LVAD type, baseline INR (median and IQR), and vitamin K dose were collected. Primary endpoints included thrombotic and bleeding events within 90 days of discharge and number of patients with INR Results Patients in the IV vitamin K group had no thrombotic events compared to 23% of patients in the “watchful waiting” group (p=0.085). There were 38.5% and 11.8% bleeding event rates in the Vitamin K and “watchful waiting” groups, respectively (p=0.091). Patients receiving Vitamin K were more likely to have an INR Conclusion Using IV vitamin K to reverse warfarin prior to a non-emergent procedure was as safe as and more efficacious than “watchful waiting” alone. The major limitation of this study is its retrospective, non-randomized nature. Future prospective evaluation with a randomized controlled trial will be needed to corroborate these findings.