University of Michigan
This is a feasibility study of uninterrupted warfarin with a one time dose of Vitamin K before a surgical procedure.
Historically, warfarin is held for 5 days before a surgical procedure to obtain a safe INR (international normalized ratio) that minimizes bleeding risk. However, there is a strong rationale for continuing warfarin uninterrupted in the perioperative space and giving a one-time vitamin K dose to get a safe INR pre-operatively. This feasibility study will recruit patients who use warfarin and will measure their INR response after receiving a single pre-procedure vitamin K dose. This study will also assess the use of a one-time "loading" dose immediately post-operative to help the INR return to t…
Inclusion Criteria: * Warfarin therapy for ≥3 months * Use of home INR testing equipment * Scheduled for a surgical procedure that requires INR ≤ 1.5 (typically achieved with warfarin interruption) * INR ≤ 4 on day 7-10 prior to procedure Exclusion Criteria: * Surgical procedure does not require INR ≤1.5 (typically achieved with warfarin interruption) * Surgical procedure with a high risk of bleeding or complications (urologic procedures, bronchoscopy, epidural injections, nerve blocks, spinal surgery) * Warfarin therapy for \< 3 months * Lack of English language proficiency * Use of a Hear…
10 mg of oral vitamin K will be given approximately 36-48 hours before procedure.
Patients receive their standard warfarin dosing without interruption.
Patients receive their standard warfarin dosing without interruption; patients also receive a one time loading dose (twice normal dose) of warfarin on the evening following their procedure.
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