Scientific Evidence based guide for rat poison using vit K

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Scientific Evidence based guideline for rat poison

"Normal preschool-aged children with unintentional acute exposures to superwarfarin rodenticides do not require any routine follow-up laboratory studies and do not require any medical intervention. " Children are currently treated by pediatricians with what some anonymous veterinarian critics call "benign neglect".
see
http://www.ebvet.com/forum/viewtopic.ph ... 966a9#2168

Veterinarians while having been made aware that

1. Animals that have ingested an anticoagulant and have a normal clotting time should not receive vitamin K1

And that

2. Prophylactic administration of vitamin K1 is not effective in preventing clotting prolongation in animal studies.

see

http://www.ebvet.com/forum/viewtopic.ph ... 36c8b44fff

often promote to each other and to those vets who politically try to control our veterinary profession by saying that supplementation with oral vitamin K is a good idea for dogs and cats when it is not advised for children under similar rat poison exposure circumstances. Vets promoting vitamin supplements should make clients aware of the risk supplementing with Vit K

Contraindications/Precautions

Many veterinary clinicians state that the intravenous use of Vet k1 (phytonadione) is contraindicated because of increased risk of anaphylaxis development, and while oral Vit K dosage regimens are promoted for asymptomatic dogs and cats that have just ingested rat poison the FDA-CVM has warned to avoid administering Vit K IV. Phytonadione is contraindicated in patients hypersensitive to it or any component of its formulation.

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"no study has unequivocally shown that oral vitamin K reduces the risk of hemorrhage."

Notice in this study they are now running in humans the number one reason physicians do not send home oral vit k when they find increased clotting time in people taking rat poison (warfarin) is because the Physicians say they do not think oral vit k reduces the risk of hemorrhage even when clotting times are delayed. When this link was put in the study was not finished. It may be finished by the time you read this.

http://clinicaltrials.gov/ct2/show/reco ... %22&rank=1

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EFFECTIVENESS OF LOW DOSE ORAL VITAMIN K FOR PATIENTS WITH ELEVATED INR VALUES: RESULTS OF RANDOMIZED TRIAL EXAMINING CLINICAL OUTCOMES

Abstract number: P-S-219

Crowther1 M.A., Ageno2 W., Garcia3 D., Wang1 L., Witt4 D., Clark4 N., Blostein5 M., Kahn5 S., Schulman1 S., Kovacs6 M.J., Wells7 P., Anderson8 D., Kearon1 C., Ginsberg1 J., Selby9 R., Siragusa10 S., Silingardi11 M., Douketis1 J.

11Medicine, McMaster University, Hamilton, Canada 1010Hematology, Univ of Palermo, Palermo 1111Medicine, Regio Emilia Hospital, Regio Emilia, Italy 22Medicine, Univ of Insurbia, Varese, Italy 33Medicine, University of New Mexico, Albuquerque 44Pharmacy, Kaiser Permanente, Denver, United States 55Medicine, McGill, Montreal 66Medicine, Univ of Western Ontario, London 77Medicine, Univ of Ottawa, Ottawa 88Medicine, Dalhousie, Halifax 99Medicine, Univ of Toronto, Toronto, Canada

How-to-cite Crowther MA, Ageno W, Garcia D, Wang L, Witt D, Clark N, Blostein M, Kahn S, Schulman S, Kovacs MJ, Wells P, Anderson D, Kearon C, Ginsberg J, Selby R, Siragusa S, Silingardi M, Douketis J. EFFECTIVENESS OF LOW DOSE ORAL VITAMIN K FOR PATIENTS WITH ELEVATED INR VALUES: RESULTS OF RANDOMIZED TRIAL EXAMINING CLINICAL OUTCOMES. J Thromb Haemost 2007; 5 Supplement 2: P-S-219

Abstract
Introduction: Patients anticoagulated with warfarin often have INRs above the desired range. Although oral vitamin K effectively reduces such INR values towards the normal range there is no evidence that it reduces bleeding and, paradoxically, it may cause thrombosis. We sought to address this knowledge gap with a multicentre, placebo controlled clinical trial.

Methods: Patients were enrolled between September 2004 and June 2006 in 14 clinical centres in Canada, the United States and Italy. All patients were assessed for overt bleeding and if absent were allocated to receive 1.25 mg oral vitamin K1 (V) or matching placebo (P). INR values and independently adjudicated episodes of bleeding, thromboembolism (TE) and death were assessed over the ensuing 90 days.

Results: 724 (V356/P368) patients were enrolled. Mean age was 67 years old and 47% were female. The median INR at admission was 5.5 (range 4.5 to 10). Indications for warfarin therapy included atrial fibrillation (44%), treatment of DVT (31%), valvular heart disease (22%). Seventy-seven percent of patients had a target INR of 2.0 to 3.0, and 8% had known malignancy.

In the 90 days after enrolment 17 patients died (V7/P10), 7 had objectively confirmed TE (V4/P3), and 127 had at least one bleeding complication (V60/P67). There were no statistically significant differences for any comparison. Within 7 days of enrolment 65 bleeding complications (V26/P39) occurred in 55 patients (V22/P33) (relative risk 0.67, 95% CI 0.37 to 1.21). Major bleeds occurred in 3 patients (V1/P2).

Conclusions: Low dose oral vitamin K did not convincingly reduce the overall risk of bleeding when administered to patients with INR values of 4.5 to 10.0.









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