Document Detail

Intravenous vitamin K1 prior to orthotopic heart transplantation: effects in vivo and in vitro.
MedLine Citation:
PMID:  9061118     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Vitamin K1 is used to reverse warfarin's anticoagulant action. It is unclear whether intravenous vitamin K1 is safe or efficacious prior to urgent cardiac surgery. METHODS: We retrospectively and prospectively examined the effects of preoperative intravenous vitamin K1 in vivo (administered for warfarin reversal immediately before heart transplantation) on intraoperative blood product utilization, hemodynamics and coagulation parameters. We also determined the direct effects of vitamin K1 in vitro on rings of human saphenous vein and internal mammary artery. RESULTS: In the retrospective limb, 29 of 67 patients were administered vitamin K1 preoperatively via slow intravenous infusion. Vitamin K1 administration produced no adverse outcome but did not affect subsequent perioperative use of blood products. In the prospective limb (n = 10), vitamin K1 significantly (P < or = 0.01, Student t-test) altered mean arterial pressure (from 85 +/- 15 to 76 +/- 16 mmHg), systemic vascular resistance (from 1364 +/- 308 to 1078 +/- 252, and cardiac index (from 2.3 +/- 0.3 to 2.7 +/- 0.3 L/min/m2) (mean +/- SD). Significant decreases in prothrombin time (19.8 +/- 2.7 to 17.7 +/- 1.8 s) and activated clotting time (164 +/- 26 to 137 +/- 24 s) were observed at 60 min. In vitro vitamin K1 (10(-7) to 10(-4) M) had no effect on the tone of noradrenaline-constricted rings. CONCLUSIONS: Vitamin K1, administered by intravenous infusion prior to heart transplantation, did not alter subsequent perioperative blood product administration. Vitamin K1 rapidly reversed the anticoagulant effect of warfarin and produced modest hemodynamic changes. The decrease in systemic vascular resistance is probably not due to a direct effect of vitamin K1 on vascular smooth muscle.
R E Barnette; W W Wendling; J W Schweiger; N W Brister; S A Schartel; D Chen; C A Shuman; J B McClurken; V Jeevanandam
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Publication Detail:
Type:  In Vitro; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  41     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-05-08     Completed Date:  1997-05-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  78-83     Citation Subset:  IM    
Department of Anesthesiology, Temple University Hospital, Philadelphia, USA.
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MeSH Terms
Anticoagulants / administration & dosage
Blood Coagulation Tests
Blood Transfusion
Heart Transplantation*
Hemodynamics / drug effects
Hemostatics / administration & dosage*
Infusions, Intravenous
Mammary Arteries / drug effects,  physiology
Muscle, Smooth, Vascular / drug effects
Preoperative Care
Prospective Studies
Retrospective Studies
Saphenous Vein / drug effects,  physiology
Vascular Resistance / drug effects
Vasoconstriction / drug effects
Vitamin K / administration & dosage*
Warfarin / administration & dosage
Reg. No./Substance:
0/Anticoagulants; 0/Hemostatics; 12001-79-5/Vitamin K; 81-81-2/Warfarin

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