Did the world really need another clinical trial looking at vitamin K reversal of coumadin? Well it's got one in no less a journal than Annals of Internal Medicine. I thought this question must have been answered by now by a handful of studies: if your patient has an excessive INR from coumadin you can quickly correct the number with vitamin K. The problem as the new article reports is that bleeding is not necessarily improved with correction of the INR. Wow. This leads to the larger question of "If people with a high INR have no excess bleeding how aggressive do we have to be with an elevated INR?" I can remember getting a breathless consult from the ER as a fellow over just this question: old guy atrial fib coumadin INR of 8 no bleeding what do you do? According to the new article giving vitamin K might just be treating the doctor (not that there's anything wrong with that). http://www.annals.org/cgi/content/short/150/5/I-25?rss=1