Category: Professional Posters
Purpose: Patients with liver failure and cirrhosis often present with coagulopathy due to impaired production of coagulation factors. Vitamin K is frequently used in these patients to correct coagulopathy despite a lack of supporting evidence and optimal dosing regimen. We hypothesized that if vitamin K is to have any benefit in reducing the international normalized ratio (INR), the 10mg dose given intravenously would be most likely to demonstrate an effect. The purpose of this study is to validate the efficacy of intravenous vitamin K 10mg dosing in hospitalized patients with coagulopathy and cirrhosis versus other doses and routes of vitamin K.
Methods: A retrospective chart review was conducted to evaluate all patients admitted to our institution between March 2017 to September 2018 who received vitamin K via any route. Patients were included if they were at least 18 years of age and had cirrhosis related coagulopathy defined as INR greater than 1.5 at any point during their hospitalization. Patients who received any blood products on the same day or within 72 hours of the vitamin K dose or received it for any indication other than coagulopathy in cirrhosis were excluded. Included patients were divided into two groups: 1) patients who initially received 10mg vitamin K intravenously and 2) patients who received vitamin K in any other dose or route. The major outcomes measured were the percentage decrease of INR within 72 hours of the last dose of vitamin K and whether an INR of less than 1.5 was achieved. A secondary analysis was also performed that compared intravenous and oral vitamin K irrespective of the dose and evaluated the same outcomes. Data was analyzed using the Fisher’s exact test and the Mann-Whitney U test. This study was approved by our local institutional review board (IRB).
Results: A total of twenty-two patients with a documented diagnosis of cirrhosis were included in our analysis with a mean age of 56.8 years. The average baseline initial INR was 2 and the average vitamin K dose given via any route was 9.6mg. Seven patients (31.8 percent) received oral vitamin K and the remaining fifteen patients (68.2 percent) received it via the intravenous route. Of those fifteen patients, seven patients (46.6 percent) received a 10mg intravenous dose. The average percentage decrease in INR within 72 hours in the 10mg intravenous group was 15.6 percent versus 14 percent in the second group (p=0.19). Two patients (28 percent) achieved an INR less than 1.5 within 72 hours in the 10mg intravenous group versus six patients (40 percent) in the second group (p=0.67). As for the secondary analysis irrespective of the dose given, the intravenous vitamin K group had an average decrease in INR within 72 hours of 19.4 percent versus 4.1 percent in the oral vitamin K group (p=0.03). Six patients (40 percent) of the intravenous group achieved an INR less than 1.5 within 72 hours versus two patients (28 percent) in the oral group (p=0.67).
Conclusion: The results of this study suggest that vitamin K was poorly effective in reversing coagulopathy in cirrhosis. If used, intravenous vitamin K might be more effective in decreasing the INR in patients with cirrhosis related coagulopathy versus the oral route. However, the optimal dose is unknown.