Phytonadione is often prescribed by emergency department physicians, primary care providers, internists, obstetrician-gynecologists, gastroenterologists, neonatologists, physician assistants, nurse practitioners, neurologists, and neurosurgeons for the treatment of vitamin K deficiency. Phytonadione is best prescribed/ordered and administered under the care of an interprofessional team. concluded that subcutaneous phytonadione does not produce rapid, reliable reductions in INR and that oral phytonadione is effective for warfarin-induced coagulopathy. One died of unknown causes, three died of cancer, and one died of progressive lung disease.
However, there were five deaths in the oral phytonadione compared to none in the subcutaneous phytonadione group. Only two patients (8%) who had received subcutaneous phytonadione were found to have an INR that was higher than the day prior. One day after either oral or subcutaneous phytonadione, six patients (24%) received subcutaneous phytonadione with an INR of 1.8 to 3.2 compared to 15 patients (58%) who received oral phytonadione P = 0.015.
The study enrolled fifty-one patients, with 25 in the subcutaneous phytonadione group and 26 in the oral phytonadione group. Patients were randomly assigned either oral or subcutaneous phytonadione with a dose of 1 mg. It was a multicenter, randomized, open-label, controlled study that evaluated the use of phytonadione in asymptomatic patients with an INR between 4.5 and 10. in 2002 investigated the use of phytonadione administration in patients with an INR of 4.5 to 10 and on warfarin therapy.
Ī randomized, controlled trial by Cowther et al. Afanasjeva concluded that giving IV phytonadione can offer an inexpensive alternative to phytonadione tablets, especially when the tablet formulation is in shortage. Also, they found that the unpleasant taste of oral phytonadione was reportedly less when mixed with orange juice. They reiterated the importance of using a filtered needle to avoid glass particles administered to patients. Afanasjeva in 2017 evaluated the safety and efficacy of IV phytonadione orally to reduce cost and in the situation that the tablet formulation of oral phytonadione is unavailable. The researchers found that warfarin reversal is not affected in patients with obesity. There was no significant difference in the route of administration or dose between the patients with obesity and the patients without obesity. The definition of warfarin reversal of warfarin is correcting an international normalized ratio (INR) to ≤ 2.0 within 72 hours after phytonadione administration. In a single-center retrospective cohort study by Luc et al., they assessed the effectiveness of phytonadione to reverse warfarin in patients with obesity defined as a body mass index (BMI) ≥ 30 kg/m^2. IV 10 mg as soon as possible the IV infusion rate should not exceed 1 mg/minute.
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