Background
Cirrhosis impairs the liver’s ability to synthesize vitamin K–dependent coagulation factors, contributing to coagulopathy. Elevated international normalized ratio (INR) in these patients often prompts intravenous (I.V.) vitamin K administration, despite limited evidence supporting its efficacy.
Objectives
This study aimed to evaluate the impact of I.V. vitamin K administration on INR and identify factors that may predict response in patients with severe cirrhosis.
Methods
This single-center, retrospective, institutional review board–approved study included adult hospitalized patients with cirrhosis who received I.V. vitamin K. The primary outcome of this study was to evaluate the change in INR. Secondary analysis included the rate of bleeding events, in-hospital venous thromboembolism (VTE), and in-hospital mortality. Subgroup analysis and linear regression analysis were conducted.
Results
Among 134 patients, the median INR change from day 0 to day 3 was 0 [−0.4 to 0.2]. Bleeding events occurred in 19% of patients, in-hospital VTE in 3%, and mortality in 16%. Subgroup analysis showed a numerically greater INR reduction in patients with a baseline INR of greater than 2, but no differences based on Model for End-Stage Liver Disease scores or cirrhosis etiology. Multivariate analysis demonstrated that age older than 60 years and a decrease in INR of 0.5 from day 0 to 1 significantly predicted the overall change in INR.
Conclusion
Our research provides additional data to the existing literature, showcasing a lack of impact of I.V. vitamin K on INR in patients with cirrhosis. Notably, our study adds insight into the lack of benefit even in patients with more severe cirrhosis. Standardization of clinical practice recommendations to guide I.V. vitamin K use across the spectrum of cirrhosis is needed.


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