Comparing Different Routes and Doses of Phytonadione (Vitamin K) for Reversing Warfarin Treated Patients With Hip Fracture Before Surgery

• Bleeding [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
• Complications [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]

It is well known that femoral neck fractures carry a significant increase in patients' mortality and that surgical intervention is the preferred treatment.

Any delay in operating on such patients would inevitably increase their risk of developing complications. One of the reasons for such unintentional delay would be the hypercoagulative status of patients taking warfarin. The CHEST 2008 guidelines suggest reversing warfarin with Vitamin K for patients who need urgent operation. The aim of this study is to compare different roots and doses of Vitamin K.

• Bleeding
• Complications

• Drug: Phytonadione
  2.5 mg po
  Other Name: vitamin k
• Drug: Phytonadione
  0.5 mg IV
  Other Name: vitamin k

• Active Comparator: PO (by mouth)
  2.5 mg P.O Vitamin K
  Intervention: Drug: Phytonadione
• Active Comparator: IV (intravenous )
  0.5 mg IV Vitamin K
  Intervention: Drug: Phytonadione

• Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G; American College of Chest Physicians. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):160S-198S.
• Al-Rashid M, Parker MJ. Anticoagulation management in hip fracture patients on warfarin. Injury. 2005 Nov;36(11):1311-5.
• Lubetsky A, Yonath H, Olchovsky D, Loebstein R, Halkin H, Ezra D. Comparison of oral vs intravenous phytonadione (vitamin K1) in patients with excessive anticoagulation: a prospective randomized controlled study. Arch Intern Med. 2003 Nov 10;163(20):2469-73.

Inclusion Criteria:

• hip fracture patients on warfarin

Exclusion Criteria:

• pregnancy
• vitamin k sensitivity