Vitamin K 10mg Dosing Frequency
Vitamin K 10 mg is administered as a single dose (once daily), not twice daily, with subsequent dosing guided by follow-up INR measurements rather than scheduled repeated administration. 1
Evidence-Based Dosing Recommendations
Single-Dose Administration for Warfarin Reversal
The Neurocritical Care Society and Society of Critical Care Medicine recommend one dose of vitamin K 10 mg IV as the standard approach, with subsequent treatment guided by follow-up INR rather than automatic repeated dosing. 1
If the repeat INR remains elevated ≥1.4 within the first 24-48 hours after initial reversal agent administration, redosing with vitamin K 10 mg IV should be considered based on the measured INR, not on a predetermined twice-daily schedule. 1
The European Society of Cardiology similarly recommends repetitive 10 mg IV doses of vitamin K administered by slow injection for VKA-associated life-threatening bleeding, but these are given as needed based on INR response, not as scheduled BD dosing. 1
Clinical Context for Dosing Decisions
For major bleeding with elevated INR, the standard approach is 5-10 mg IV vitamin K by slow infusion over 30 minutes as a single dose, combined with prothrombin complex concentrate. 2
The half-life and pharmacokinetics of vitamin K support single-dose administration: vitamin K stimulates endogenous production of vitamin K-dependent clotting factors, which takes more than 12 hours to begin correcting hemostatic defects. 3
Monitoring INR 30 minutes to several hours after administration determines the need for additional doses, rather than giving scheduled twice-daily dosing. 2
Important Caveats
Doses exceeding 10 mg should not be used, as higher doses create a prothrombotic state and prevent re-warfarinization for days. 2
The response to vitamin K varies based on the underlying cause of coagulopathy: it is effective for warfarin reversal but has minimal effect in liver synthetic dysfunction where hepatic production of clotting factors is impaired. 3
Anaphylactoid reactions occur in approximately 3 per 100,000 IV vitamin K doses, necessitating slow infusion over 30 minutes rather than rapid bolus administration. 2