The use of vitamin K for reversal of over-warfarinization in children. Pharmacology and Management of the Vitamin K Antagonists: American College of Cheset Physicians Evidence-Based Clinical Practice Guidelines (8 th Edition). Where the concentrated 10mg/mL product is available, it must be diluted to 2mg/mL with D5W or NS prior to administration.Īnsell J, et al. This dilute form (2mg/mL) along with slow IV infusion over 10 to 20 minutes may avoid anaphylaxis that has been associated with IV administration of vitamin K. The standard product for IV administration of Vitamin K at CMH is the 2mg/mL concentration, which is readily available in medication stations on every inpatient unit. Max dose 5mg.Ĭonsider giving NovoSeven RT 90 micrograms/kg IV (alternate choice). Vitamin K 30 mcg/kg IV by slow IV infusion over 10-20 minutes (to avoid anaphylaxis). Life threatening and will cause morbidity:
Not life threatening and will not cause morbidity: The preferred route is IV, but in a child with poor or no venous access, the PO or SQ route may be used, particularly if the INR is 6-10. Oral vitamin K is effective in adults but the INR fall is slower than IV injection. Seriously ill children with liver dysfunction may require more than a single dose. Even 0.5mg (sufficient for many adults) is likely to be too high for most young children. This weight adjusted regimen is safer for pediatric patients than a universal dosage (i.e.
Vitamin K 30 mcg/kg by slow IV infusion over 10-20 minutes (to avoid anaphylaxis). If patient requires rapid warfarin reversal but has no bleeding, insignificant bleeding or bruising: significant bleeding and need for future warfarin therapy.
Choice and dose is dependent on the clinical problem-no bleeding vs.
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