Impact of Vitamin K Administration on Elevated International Normalized Ratio in Chronic Liver Disease

Limited studies assess the efficacy of vitamin K administration in patients with chronic liver disease (CLD). However, vitamin K is commonly used to treat elevations in international normalized ratio (INR) in these patients with the intended benefit of reducing bleeding risk. This retrospective, single-center cohort study aimed to evaluate the impact of vitamin K administration on INR in patients with CLD. Hospitalized patients >= 18 years of age with a diagnosis of CLD or cirrhosis and received vitamin K were included. The primary outcome was the absolute change in INR from baseline to 24 to 48 h after vitamin K administration. Secondary endpoints included subgroup analyses of the primary outcome by route of administration and single versus multidose administration, and incidence of in-hospital venous thromboembolism (VTE) or major bleeding. A total of eighty-five patients, primarily with Child-Pugh class C (76.5%), were included. Route of vitamin K administration included oral (PO) (72%) and intravenous (IV) (26%) with a mean daily dose of 8.5 +/- 2.3 mg. The absolute change in INR was -0.07 +/- -0.35 following vitamin K administration. There was no difference in absolute INR change between single versus multiple dose administration (-0.16 +/- -0.35 and -0.03 +/- -0.35; P= .13) or between PO versus IV administration (-0.06 +/- -0.23 and -0.18 +/- -0.48; P = .11). The incidences of in-hospital VTE and major bleeding were 2.4% and 3.5%, respectively. The administration of vitamin K in hospitalized patients with CLD resulted in minimal INR change, suggesting this intervention may not have the intended benefit of reducing bleeding risk.

Automated summary

Limited studies have assessed the efficacy of vitamin K administration in patients with chronic liver disease (CLD). However, the results of this retrospective, single-center cohort study suggest that the administration of vitamin K in hospitalized patients with CLD may not have the intended benefit of reducing bleeding risk, as the change in international normalized ratio (INR) following vitamin K administration was minimal.