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Oral Vitamin K Versus Placebo to Correct Excessive Anticoagulation in Patients Receiving Warfarin

May 06, 2009
Institution: Exempla St Joseph Hosp PubMed Articles in PubMed by Author: Crowther, M. A. Kearon, C. ARTICLE Oral Vitamin K Versus Placebo to Correct Excessive Anticoagulation in Patients Receiving Warfarin A Randomized Trial Mark A. Crowther, MD, MSc; Walter Ageno, MD; David Garcia, MD; Luqi Wang, PhD; Dan M. Witt, PharmD; Nathan P. Clark, PharmD; Mark D. Blostein, MD; Susan R. Kahn, MD, MSc; Sara K. Vesely, PhD; Sam Schulman, MD; Michael J. Kovacs, MD; Marc A. Rodger, MD, MSc; Phillip Wells, MD, MSc; David Anderson, MD, MSc; Jeffery Ginsberg, MD; Rita Selby, MD, MSc; Sergio Siragusa, MD; Mauro Silingardi, MD; Mary Beth Dowd, PharmD; and Clive Kearon, MD, PhD 3 March 2009 | Volume 150 Issue 5 | Pages 293-300 Background: Low-dose oral vitamin K decreases the international normalized ratio (INR) in overanticoagulated patients who receive warfarin therapy. Its effects on bleeding events are uncertain. Objective: To see whether low-dose oral vitamin K reduces bleeding events over 90 days in patients with warfarin-associated coagulopathy. Design: Multicenter, randomized, placebo-controlled trial. Randomization was computer-generated, and participants were allocated to trial groups by using sequentially numbered study drug containers. Patients, caregivers, and those who assessed outcomes were blinded to treatment assignment. Setting: 14 anticoagulant therapy clinics in Canada, the United States, and Italy. Patients: Nonbleeding patients with INR values of 4.5 to 10.0. Intervention: Oral vitamin K, 1.25 mg (355 patients randomly assigned; 347 analyzed), or matching placebo (369 patients randomly assigned; 365 analyzed). Measurements: Bleeding events (primary outcome), thromboembolism, and death (secondary outcomes). Results: 56 patients (15.8%) in the vitamin K group and 60 patients (16.3%) in the placebo group had at least 1 bleeding complication (absolute difference, –0.5 percentage point [95% CI, –6.1 to 5.1 percentage points]); major bleeding events occurred in 9 patients (2.5%) in the vitamin K group and 4 patients (1.1%) in the placebo group (absolute difference, 1.5 percentage points [CI, –0.8 to 3.7 percentage points]). Thromboembolism occurred in 4 patients (1.1%) in the vitamin K group and 3 patients (0.8%) in the placebo group (absolute difference, 0.3 percentage point [CI, –1.4 to 2.0 percentage points]). Other adverse effects were not assessed. The day after treatment, the INR had decreased by a mean of 1.4 in the placebo group and 2.8 in the vitamin K group (P < 0.001).="" limitation:="" patients="" who="" were="" actively="" bleeding="" were="" not="" included,="" and="" warfarin="" dosing="" after="" enrollment="" was="" not="" mandated="" or="" followed.="" conclusion:="" low-dose="" oral="" vitamin="" k="" did="" not="" reduce="" bleeding="" in="" warfarin="" recipients="" with="" inrs="" of="" 4.5="" to="" 10.0.="" funding:="" canadian="" institutes="" of="" health="" research="" and="" italian="" ministry="" of="" universities="" and="" research.="" editors'="" notes="" --------------------------------------------------------------------------------="" context="" vitamin="" k="" decreases="" the="" international="" normalized="" ratio="" (inr)="" in="" overanticoagulated="" patients="" who="" receive="" warfarin="" therapy,="" but="" its="" effect="" on="" clinical="" outcomes="" is="" less="" clear.="" contribution="" trial="" investigators="" detected="" no="" differences="" in="" the="" frequency="" of="" bleeding,="" thromboembolism,="" or="" death="" among="" overanticoagulated="" patients="" who="" received="" warfarin="" therapy="" and="" were="" randomly="" assigned="" to="" receive="" low-dose="" vitamin="" k="" or="" placebo.="" caution="" the="" study="" was="" underpowered="" to="" detect="" differences="" in="" major="" bleeding.="" implication="" low-dose="" vitamin="" k="" corrects="" the="" inr="" in="" overanticoagulated="" patients="" who="" received="" warfarin="" therapy,="" but="" it="" has="" little="" effect="" on="" clinical="" outcomes.="" withdrawal="" of="" warfarin="" may="" be="" all="" that="" is="" necessary="" to="" manage="" elevated="" inrs.="" —the="" editors="" author="" and="" article="" information="" --------------------------------------------------------------------------------="" from="" mcmaster="" university,="" hamilton,="" ontario,="" canada;="" university="" of="" insubria,="" varese,="" italy;="" university="" of="" new="" mexico,="" albuquerque,="" new="" mexico;="" kaiser="" permanente,="" denver,="" colorado;="" mcgill="" university,="" montreal,="" quebec,="" canada;="" university="" of="" western="" ontario,="" london,="" ontario,="" canada;="" university="" of="" ottawa,="" ottawa,="" ontario,="" canada;="" dalhousie="" university,="" halifax,="" nova="" scotia,="" canada;="" university="" of="" toronto,="" toronto,="" ontario,="" canada;="" university="" of="" palermo,="" palermo,="" italy;="" reggio="" emilia="" hospital,="" reggio="" emilia,="" italy;="" and="" university="" of="" oklahoma,="" oklahoma="" city,="" oklahoma.="" grant="" support:="" by="" the="" canadian="" institutes="" of="" health="" research="" and="" the="" italian="" ministry="" of="" universities.="" potential="" financial="" conflicts="" of="" interest:="" employment:="" l.="" wang="" (mcmaster="" university).="" consultancies:="" m.a.="" crowther="" (anton="" pharmaceuticals).="" reproducible="" research="" statement:="" study="" protocol:="" available="" from="" http://www.clinicaltrials.gov.="" statistical="" code="" and="" data="" set:="" available="" from="" dr.="" crowther="" (e-mail,="" crowthrm@mcmaster.ca)="" after="" approval="" by="" the="" steering="" committee.="" requests="" for="" single="" reprints:="" mark="" a.="" crowther,="" md,="" msc,="" division="" of="" hematology="" and="" thromboembolism,="" mcmaster="" university="" faculty="" of="" health="" sciences,="" room="" l208,="" st.="" joseph's="" hospital,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8n="" 4a6,="" canada;="" e-mail,="" crowthrm@mcmaster.ca.="" current="" author="" addresses:="" dr.="" crowther:="" division="" of="" hematology="" and="" thromboembolism,="" mcmaster="" university="" faculty="" of="" health="" sciences,="" room="" l208,="" st.="" joseph's="" hospital,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8n="" 4a6,="" canada.="" dr.="" ageno:="" department="" of="" internal="" medicine,="" universita="" degli="" studi="" dell'insubria-varese,="" via="" speroni="" 5,="" varese,="" italy="" 21100.="" dr.="" garcia:="" university="" of="" new="" mexico,="" 5th="" ambulatory="" care="" center,="" 2211="" lomas="" boulevard="" ne,="" albuquerque,="" nm="" 87131.="" dr.="" wang:="" st.="" joseph's="" healthcare,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8s="" 2g9,="" canada.="" drs.="" witt,="" clark,="" and="" dowd:="" kaiser="" permanente="" colorado="" region,="" 280="" exempla="" circle,="" lafayette,="" co="" 80026.="" dr.="" blostein:="" mcgill="" university,="" 3755="" côte="" sainte-catherine,="" montreal,="" quebec="" m3t="" 1e2,="" canada.="" dr.="" kahn:="" jewish="" general="" hospital="" 3755="" côte="" sainte-catherine,="" a-127,="" montreal,="" quebec="" h3t="" 1e2,="" canada.="" dr.="" vesely:="" the="" university="" of="" oklahoma,="" health="" sciences="" centre,="" p.o.="" box="" 26901,="" oklahoma="" city,="" ok="" 73126-0901.="" dr.="" schulman:="" mcmaster="" university,="" hamilton="" general="" hospital,="" 237="" barton="" street="" east,="" hamilton,="" ontario="" l8l="" 2x2,="" canada.="" dr.="" kovacs:="" hematology="" division,="" london="" health="" sciences="" centre,="" 800="" commissioners="" road="" east,="" london,="" ontario="" n6a="" 4g5,="" canada.="" dr.="" rodger:="" the="" ottawa="" hospital,="" 1812,="" ebox="" 201,="" 501="" smyth="" road,="" ottawa,="" ontario="" k1h="" 8l6,="" canada.="" dr.="" wells:="" the="" ottawa="" hospital,="" civic="" site,="" suite="" f649,="" 1053="" carling="" avenue,="" ottawa,="" ontario="" k1y="" 4e9,="" canada.="" dr.="" anderson:="" dalhousie="" university,="" halifax,="" nova="" scotia="" b3h="" 3j5,="" canada.="" dr.="" ginsberg:="" mcmaster="" university,="" 1200="" main="" street="" west,="" hsc="" 3x28,="" hamilton,="" ontario="" l8n="" 3z5,="" canada.="" dr.="" selby:="" sunnybrook="" health="" sciences="" centre,="" room="" 0675a,="" 2075="" bayview="" avenue,="" toronto,="" ontario="" m4n="" 3m5,="" canada.="" dr.="" siragusa:="" cattedra="" ed="" u.o.="" di="" ematologia="" con="" trapianto,="" azienda="" ospedaliera="" universitaria="" policlinico="" p.="" giaccone,="" via="" del="" vespro="" 127,="" i-90127="" palermo,="" italy.="" dr.="" silingardi:="" arcispedale="" s.="" maria="" nuova,="" azienda="" ospedaliera,="" viale="" risorgimento="" 80,="" 42100="" reggio="" emilia,="" italy.="" dr.="" kearon:="" mcmaster="" university,="" henderson="" general="" hospital,="" 711="" concession="" street,="" 40="" wing,="" ground="" floor,="" room="" 115,="" hamilton,="" ontario="" l8v="" 1c3,="" canada.="" author="" contributions:="" conception="" and="" design:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" s.="" schulman,="" p.="" wells,="" j.="" ginsberg,="" r.="" selby,="" c.="" kearon.="" analysis="" and="" interpretation="" of="" the="" data:="" m.a.="" crowther,="" w.="" ageno,="" l.="" wang,="" d.m.="" witt,="" n.p.="" clark,="" s.k.="" vesely,="" s.="" schulman,="" m.a.="" rodger,="" d.="" anderson.="" drafting="" of="" the="" article:="" m.a.="" crowther,="" w.="" ageno,="" d.m.="" witt,="" n.p.="" clark,="" p.="" wells,="" d.="" anderson.="" critical="" revision="" of="" the="" article="" for="" important="" intellectual="" content:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" d.m.="" witt,="" n.p.="" clark,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" m.a.="" rodger,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" s.="" siragusa,="" c.="" kearon.="" final="" approval="" of="" the="" article:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" m.d.="" blostein,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" s.="" siragusa,="" c.="" kearon.="" provision="" of="" study="" materials="" or="" patients:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" d.m.="" witt,="" n.p.="" clark,="" m.d.="" blostein,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" m.="" silingardi,="" m.b.="" dowd,="" c.="" kearon.="" statistical="" expertise:="" m.a.="" crowther,="" l.="" wang,="" s.k.="" vesely,="" m.a.="" rodger.="" obtaining="" of="" funding:="" m.a.="" crowther,="" w.="" ageno,="" m.j.="" kovacs,="" m.a.="" rodger,="" p.="" wells,="" r.="" selby.="" administrative,="" technical,="" or="" logistic="" support:="" m.a.="" crowther,="" d.="" garcia,="" s.r.="" kahn,="" m.b.="" dowd.="" collection="" and="" assembly="" of="" data:="" m.a.="" crowther,="" l.="" wang,="" d.m.="" witt,="" n.p.="" clark,="" s.="" siragusa,="" m.b.="" dowd.="" clinicaltrials.gov="" registration="" number:="" nct00143715.="" related="" articles="" in="" annals:="" summaries="" for="" patients="" is="" vitamin="" k="" helpful="" for="" people="" who="" have="" taken="" too="" much="" warfarin?="" annals="" 2009="" 150:="" i-25.="" [full="" text]="" this="" article="" has="" been="" cited="" by="" other="" articles:="" all="" you="" need="" to="" read="" in="" the="" other="" general="" journals="" bmj,="" march="" 11,="" 2009;="" 338(mar11_1):="" b963="" -="" b963.="" [full="" text]="" --------------------------------------------------------------------------------="" vitamin="" k="" for="" warfarin-induced="" hypocoagulation="" journal="" watch="" cardiology,="" march="" 4,="" 2009;="" 2009(304):="" 1="" -="" 1.="" [full="" text]="" --------------------------------------------------------------------------------="" rapid="" responses:="" read="" all="" rapid="" responses="" oral="" vitamin="" k="" versus="" placebo="" to="" correct="" excessive="" anticoagulation="" in="" patients="" receiving="" warfarin="" ahmad="" kaako="" annals="" online,="" 9="" mar="" 2009="" [full="" text]="" oral="" vitamin="" k:="" accp="" guidelines="" still="" apply="" robert="" c="" pendleton,="" et="" al.="" annals="" online,="" 9="" mar="" 2009="" [full="" text]="" vitamin="" k:="" to="" give="" or="" not="" to="" give?="" vittorio="" pengo,="" et="" al.="" annals="" online,="" 13="" mar="" 2009="" [full="" text]="" the="" clinical="" use="" of="" vitamin="" k="" yu="" han,="" et="" al.="" annals="" online,="" 16="" mar="" 2009="" [full="" text]="" vitamin="" k="" to="" correct="" excessive="" anticoagulation="" p="" dileep="" kumar="" annals="" online,="" 25="" mar="" 2009="" [full="" text]="" let's="" keep="" our="" eye="" on="" the="" ball="" ayad="" jindeel,="" et="" al.="" annals="" online,="" 3="" apr="" 2009="" [full="" text]="" letter="" in="" response="" to="" crowther="" et="" al.,="" annals="" of="" internal="" medicine,="" 150,="" 2009,="" 293-300="" mark="" w="" swaim,="" et="" al.="" annals="" online,="" 7="" apr="" 2009="" [full="" text]="" --------------------------------------------------------------------------------="" home="" |="" current="" issue="" |="" past="" issues="" |="" in="" the="" clinic="" |="" acp="" journal="" club="" |="" cme="" |="" collections="" |="" audio/video="" |="" mobile="" |="" subscribe="" |="" tools="" |="" help="" |="" acp="" online="" copyright="" ©="" 2009="" by="" the="" american="" college="" of="" physicians.="" 0.001).="" limitation:="" patients="" who="" were="" actively="" bleeding="" were="" not="" included,="" and="" warfarin="" dosing="" after="" enrollment="" was="" not="" mandated="" or="" followed.="" conclusion:="" low-dose="" oral="" vitamin="" k="" did="" not="" reduce="" bleeding="" in="" warfarin="" recipients="" with="" inrs="" of="" 4.5="" to="" 10.0.="" funding:="" canadian="" institutes="" of="" health="" research="" and="" italian="" ministry="" of="" universities="" and="" research.="" editors'="" notes="" --------------------------------------------------------------------------------="" context="" vitamin="" k="" decreases="" the="" international="" normalized="" ratio="" (inr)="" in="" overanticoagulated="" patients="" who="" receive="" warfarin="" therapy,="" but="" its="" effect="" on="" clinical="" outcomes="" is="" less="" clear.="" contribution="" trial="" investigators="" detected="" no="" differences="" in="" the="" frequency="" of="" bleeding,="" thromboembolism,="" or="" death="" among="" overanticoagulated="" patients="" who="" received="" warfarin="" therapy="" and="" were="" randomly="" assigned="" to="" receive="" low-dose="" vitamin="" k="" or="" placebo.="" caution="" the="" study="" was="" underpowered="" to="" detect="" differences="" in="" major="" bleeding.="" implication="" low-dose="" vitamin="" k="" corrects="" the="" inr="" in="" overanticoagulated="" patients="" who="" received="" warfarin="" therapy,="" but="" it="" has="" little="" effect="" on="" clinical="" outcomes.="" withdrawal="" of="" warfarin="" may="" be="" all="" that="" is="" necessary="" to="" manage="" elevated="" inrs.="" —the="" editors="" author="" and="" article="" information="" --------------------------------------------------------------------------------="" from="" mcmaster="" university,="" hamilton,="" ontario,="" canada;="" university="" of="" insubria,="" varese,="" italy;="" university="" of="" new="" mexico,="" albuquerque,="" new="" mexico;="" kaiser="" permanente,="" denver,="" colorado;="" mcgill="" university,="" montreal,="" quebec,="" canada;="" university="" of="" western="" ontario,="" london,="" ontario,="" canada;="" university="" of="" ottawa,="" ottawa,="" ontario,="" canada;="" dalhousie="" university,="" halifax,="" nova="" scotia,="" canada;="" university="" of="" toronto,="" toronto,="" ontario,="" canada;="" university="" of="" palermo,="" palermo,="" italy;="" reggio="" emilia="" hospital,="" reggio="" emilia,="" italy;="" and="" university="" of="" oklahoma,="" oklahoma="" city,="" oklahoma.="" grant="" support:="" by="" the="" canadian="" institutes="" of="" health="" research="" and="" the="" italian="" ministry="" of="" universities.="" potential="" financial="" conflicts="" of="" interest:="" employment:="" l.="" wang="" (mcmaster="" university).="" consultancies:="" m.a.="" crowther="" (anton="" pharmaceuticals).="" reproducible="" research="" statement:="" study="" protocol:="" available="" from="" http://www.clinicaltrials.gov.="" statistical="" code="" and="" data="" set:="" available="" from="" dr.="" crowther="" (e-mail,="" crowthrm@mcmaster.ca)="" after="" approval="" by="" the="" steering="" committee.="" requests="" for="" single="" reprints:="" mark="" a.="" crowther,="" md,="" msc,="" division="" of="" hematology="" and="" thromboembolism,="" mcmaster="" university="" faculty="" of="" health="" sciences,="" room="" l208,="" st.="" joseph's="" hospital,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8n="" 4a6,="" canada;="" e-mail,="" crowthrm@mcmaster.ca.="" current="" author="" addresses:="" dr.="" crowther:="" division="" of="" hematology="" and="" thromboembolism,="" mcmaster="" university="" faculty="" of="" health="" sciences,="" room="" l208,="" st.="" joseph's="" hospital,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8n="" 4a6,="" canada.="" dr.="" ageno:="" department="" of="" internal="" medicine,="" universita="" degli="" studi="" dell'insubria-varese,="" via="" speroni="" 5,="" varese,="" italy="" 21100.="" dr.="" garcia:="" university="" of="" new="" mexico,="" 5th="" ambulatory="" care="" center,="" 2211="" lomas="" boulevard="" ne,="" albuquerque,="" nm="" 87131.="" dr.="" wang:="" st.="" joseph's="" healthcare,="" 50="" charlton="" avenue="" east,="" hamilton,="" ontario="" l8s="" 2g9,="" canada.="" drs.="" witt,="" clark,="" and="" dowd:="" kaiser="" permanente="" colorado="" region,="" 280="" exempla="" circle,="" lafayette,="" co="" 80026.="" dr.="" blostein:="" mcgill="" university,="" 3755="" côte="" sainte-catherine,="" montreal,="" quebec="" m3t="" 1e2,="" canada.="" dr.="" kahn:="" jewish="" general="" hospital="" 3755="" côte="" sainte-catherine,="" a-127,="" montreal,="" quebec="" h3t="" 1e2,="" canada.="" dr.="" vesely:="" the="" university="" of="" oklahoma,="" health="" sciences="" centre,="" p.o.="" box="" 26901,="" oklahoma="" city,="" ok="" 73126-0901.="" dr.="" schulman:="" mcmaster="" university,="" hamilton="" general="" hospital,="" 237="" barton="" street="" east,="" hamilton,="" ontario="" l8l="" 2x2,="" canada.="" dr.="" kovacs:="" hematology="" division,="" london="" health="" sciences="" centre,="" 800="" commissioners="" road="" east,="" london,="" ontario="" n6a="" 4g5,="" canada.="" dr.="" rodger:="" the="" ottawa="" hospital,="" 1812,="" ebox="" 201,="" 501="" smyth="" road,="" ottawa,="" ontario="" k1h="" 8l6,="" canada.="" dr.="" wells:="" the="" ottawa="" hospital,="" civic="" site,="" suite="" f649,="" 1053="" carling="" avenue,="" ottawa,="" ontario="" k1y="" 4e9,="" canada.="" dr.="" anderson:="" dalhousie="" university,="" halifax,="" nova="" scotia="" b3h="" 3j5,="" canada.="" dr.="" ginsberg:="" mcmaster="" university,="" 1200="" main="" street="" west,="" hsc="" 3x28,="" hamilton,="" ontario="" l8n="" 3z5,="" canada.="" dr.="" selby:="" sunnybrook="" health="" sciences="" centre,="" room="" 0675a,="" 2075="" bayview="" avenue,="" toronto,="" ontario="" m4n="" 3m5,="" canada.="" dr.="" siragusa:="" cattedra="" ed="" u.o.="" di="" ematologia="" con="" trapianto,="" azienda="" ospedaliera="" universitaria="" policlinico="" p.="" giaccone,="" via="" del="" vespro="" 127,="" i-90127="" palermo,="" italy.="" dr.="" silingardi:="" arcispedale="" s.="" maria="" nuova,="" azienda="" ospedaliera,="" viale="" risorgimento="" 80,="" 42100="" reggio="" emilia,="" italy.="" dr.="" kearon:="" mcmaster="" university,="" henderson="" general="" hospital,="" 711="" concession="" street,="" 40="" wing,="" ground="" floor,="" room="" 115,="" hamilton,="" ontario="" l8v="" 1c3,="" canada.="" author="" contributions:="" conception="" and="" design:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" s.="" schulman,="" p.="" wells,="" j.="" ginsberg,="" r.="" selby,="" c.="" kearon.="" analysis="" and="" interpretation="" of="" the="" data:="" m.a.="" crowther,="" w.="" ageno,="" l.="" wang,="" d.m.="" witt,="" n.p.="" clark,="" s.k.="" vesely,="" s.="" schulman,="" m.a.="" rodger,="" d.="" anderson.="" drafting="" of="" the="" article:="" m.a.="" crowther,="" w.="" ageno,="" d.m.="" witt,="" n.p.="" clark,="" p.="" wells,="" d.="" anderson.="" critical="" revision="" of="" the="" article="" for="" important="" intellectual="" content:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" d.m.="" witt,="" n.p.="" clark,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" m.a.="" rodger,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" s.="" siragusa,="" c.="" kearon.="" final="" approval="" of="" the="" article:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" m.d.="" blostein,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" s.="" siragusa,="" c.="" kearon.="" provision="" of="" study="" materials="" or="" patients:="" m.a.="" crowther,="" w.="" ageno,="" d.="" garcia,="" d.m.="" witt,="" n.p.="" clark,="" m.d.="" blostein,="" s.r.="" kahn,="" s.="" schulman,="" m.j.="" kovacs,="" p.="" wells,="" d.="" anderson,="" j.="" ginsberg,="" r.="" selby,="" m.="" silingardi,="" m.b.="" dowd,="" c.="" kearon.="" statistical="" expertise:="" m.a.="" crowther,="" l.="" wang,="" s.k.="" vesely,="" m.a.="" rodger.="" obtaining="" of="" funding:="" m.a.="" crowther,="" w.="" ageno,="" m.j.="" kovacs,="" m.a.="" rodger,="" p.="" wells,="" r.="" selby.="" administrative,="" technical,="" or="" logistic="" support:="" m.a.="" crowther,="" d.="" garcia,="" s.r.="" kahn,="" m.b.="" dowd.="" collection="" and="" assembly="" of="" data:="" m.a.="" crowther,="" l.="" wang,="" d.m.="" witt,="" n.p.="" clark,="" s.="" siragusa,="" m.b.="" dowd.="" clinicaltrials.gov="" registration="" number:="" nct00143715.="" related="" articles="" in="" annals:="" summaries="" for="" patients="" is="" vitamin="" k="" helpful="" for="" people="" who="" have="" taken="" too="" much="" warfarin?="" annals="" 2009="" 150:="" i-25.="" [full="" text]="" this="" article="" has="" been="" cited="" by="" other="" articles:="" all="" you="" need="" to="" read="" in="" the="" other="" general="" journals="" bmj,="" march="" 11,="" 2009;="" 338(mar11_1):="" b963="" -="" b963.="" [full="" text]="" --------------------------------------------------------------------------------="" vitamin="" k="" for="" warfarin-induced="" hypocoagulation="" journal="" watch="" cardiology,="" march="" 4,="" 2009;="" 2009(304):="" 1="" -="" 1.="" [full="" text]="" --------------------------------------------------------------------------------="" rapid="" responses:="" read="" all="" rapid="" responses="" oral="" vitamin="" k="" versus="" placebo="" to="" correct="" excessive="" anticoagulation="" in="" patients="" receiving="" warfarin="" ahmad="" kaako="" annals="" online,="" 9="" mar="" 2009="" [full="" text]="" oral="" vitamin="" k:="" accp="" guidelines="" still="" apply="" robert="" c="" pendleton,="" et="" al.="" annals="" online,="" 9="" mar="" 2009="" [full="" text]="" vitamin="" k:="" to="" give="" or="" not="" to="" give?="" vittorio="" pengo,="" et="" al.="" annals="" online,="" 13="" mar="" 2009="" [full="" text]="" the="" clinical="" use="" of="" vitamin="" k="" yu="" han,="" et="" al.="" annals="" online,="" 16="" mar="" 2009="" [full="" text]="" vitamin="" k="" to="" correct="" excessive="" anticoagulation="" p="" dileep="" kumar="" annals="" online,="" 25="" mar="" 2009="" [full="" text]="" let's="" keep="" our="" eye="" on="" the="" ball="" ayad="" jindeel,="" et="" al.="" annals="" online,="" 3="" apr="" 2009="" [full="" text]="" letter="" in="" response="" to="" crowther="" et="" al.,="" annals="" of="" internal="" medicine,="" 150,="" 2009,="" 293-300="" mark="" w="" swaim,="" et="" al.="" annals="" online,="" 7="" apr="" 2009="" [full="" text]="" --------------------------------------------------------------------------------="" home="" |="" current="" issue="" |="" past="" issues="" |="" in="" the="" clinic="" |="" acp="" journal="" club="" |="" cme="" |="" collections="" |="" audio/video="" |="" mobile="" |="" subscribe="" |="" tools="" |="" help="" |="" acp="" online="" copyright="" ©="" 2009="" by="" the="" american="" college="" of="" />