The coagulopathy of liver disease: does vitamin K help?

Blood Coagul Fibrinolysis. 2013 Jan;24(1):10-7. doi: 10.1097/MBC.0b013e32835975ed.

Abstract

Vitamin K is frequently administered in cirrhotic patients to correct their coagulopathy, but evidence for such practice is lacking. We aimed to assess whether vitamin K administration increases the levels of the vitamin K-dependent factor VII (FVII), protein C, and protein S in patients with different stages of liver dysfunction. Eighty-nine patients were recruited into four groups: group 1 [hepatitis B virus (HBV) inactive carriers, n = 23]; group 2 [chronic HBV and hepatitis C virus (HCV) hepatitis, n = 21]; group 3 (cirrhosis, n = 24); group 4 (hepatocellular carcinoma, n = 21); and a healthy control group (n = 39). A single dose of 10 mg of vitamin K1 was administered subcutaneously to all patients. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen, FVII, protein C, total and free protein S, and proteins induced by vitamin K absence (PIVKA)-II (des-gamma-carboxy prothrombin) were measured at baseline and 72 h after vitamin K administration. There was progressive increment in baseline PIVKA-II, and decrements in fibrinogen, FVII, protein C, and protein S across study groups (P < 0.0001). Compared to baseline, vitamin K administration did not affect the measured parameters, whereas TT showed no reduction in any of the groups. Protein C levels declined in group 2, whereas FVII, total and free protein S did not increase in any group, for all parameters. Vitamin K therapy does not cause significant improvements in the majority of coagulation parameters and hence does not seem to be routinely indicated in patients with liver disease.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / drug therapy*
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Tests
  • Carcinoma, Hepatocellular / blood
  • Carcinoma, Hepatocellular / complications*
  • Carcinoma, Hepatocellular / diagnosis
  • Factor VII / analysis
  • Female
  • Fibrinogen / analysis
  • Hemorrhagic Disorders / blood
  • Hemorrhagic Disorders / drug therapy
  • Hemorrhagic Disorders / etiology
  • Hepatitis B, Chronic / blood
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / diagnosis
  • Hepatitis C / blood
  • Hepatitis C / complications*
  • Hepatitis C / diagnosis
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Liver Neoplasms / blood
  • Liver Neoplasms / complications*
  • Liver Neoplasms / diagnosis
  • Male
  • Middle Aged
  • Protein C / analysis
  • Protein Precursors / blood
  • Protein S / analysis
  • Prothrombin
  • Treatment Outcome
  • Vitamin K / therapeutic use*
  • Young Adult

Substances

  • Biomarkers
  • Protein C
  • Protein Precursors
  • Protein S
  • Vitamin K
  • acarboxyprothrombin
  • Factor VII
  • Prothrombin
  • Fibrinogen