What is the treatment for a 44-year-old female with severe vitamin K deficiency?

From the Guidelines

For a 44-year-old female with severe vitamin K deficiency (level <0.10), immediate treatment with vitamin K supplementation is recommended, with a dose of 10 mg administered either orally or intravenously, as suggested by the most recent and highest quality study 1. The treatment approach should prioritize correcting the coagulation defect while investigating the underlying cause of the deficiency.

• Key considerations include:
  • Administering phytonadione (vitamin K1) 10 mg intravenously slowly over 30 minutes, or orally, as the initial dose, based on the guidelines provided by 1.
  • Following up with oral vitamin K supplementation, with a dose range of 1-2 mg daily, as recommended by 1 and 1, for a period of 1-2 weeks, then adjusting based on follow-up levels.
  • If the patient has active bleeding or requires urgent surgery, considering fresh frozen plasma or prothrombin complex concentrate to rapidly correct coagulation, as suggested by 1 and 1.
  • Concurrently investigating the underlying cause of the deficiency, which may include malabsorption disorders, prolonged antibiotic use, severe liver disease, or malnutrition.
  • Monitoring coagulation parameters (PT/INR) daily initially, then weekly until stabilized, to assess the effectiveness of the treatment.
  • Providing dietary counseling to increase intake of vitamin K-rich foods, such as leafy green vegetables, broccoli, and Brussels sprouts, to support long-term management of vitamin K levels. Vitamin K is essential for the production of clotting factors II, VII, IX, and X in the liver, and severe deficiency significantly increases bleeding risk, making prompt treatment crucial to prevent potentially life-threatening hemorrhagic complications, as highlighted by the studies 1.

From the FDA Drug Label

Anticoagulant-Induced Prothrombin Deficiency in Adults To correct excessively prolonged prothrombin time caused by oral anticoagulant therapy—2. 5 to 10 mg or up to 25 mg initially is recommended. Hypoprothrombinemia Due to other causes (Antibiotics; Salicylates or other drugs; Factors limiting absorption or synthesis) 2.5 mg to 25 mg or more (rarely up to 50 mg) The patient has a low vitamin K level (<0.10), which may indicate hypoprothrombinemia.

• The recommended initial dosage for hypoprothrombinemia due to other causes in adults is 2.5 mg to 25 mg or more (rarely up to 50 mg) of vitamin K1.
• The amount and route of administration depend upon the severity of the condition and response obtained 2.
• In this case, since the patient's vitamin K level is very low, a dose of 2.5 to 10 mg of vitamin K1 could be considered, with the possibility of repeating the dose if the prothrombin time has not been shortened satisfactorily in 6 to 8 hours.

From the Research

Treatment Options for Vitamin K Deficiency

The patient in question has a vitamin K level of <0.10, which is significantly low. Considering the provided evidence, here are some potential treatment options:

• Administration of vitamin K to help increase the patient's vitamin K levels 3
• Use of four-factor prothrombin complex concentrate (4F-PCC) to rapidly reverse vitamin K antagonists and normalize the international normalized ratio (INR) 4, 5, 6
• Fresh frozen plasma (FFP) may also be considered, although 4F-PCC may be superior in normalizing INR and reducing haematoma expansion 6

Comparison of Treatment Options

The following points compare the treatment options:

• 4F-PCC has been shown to be effective in normalizing INR and reducing haematoma expansion in patients with intracranial haemorrhage related to vitamin K antagonists 6
• FFP may be associated with a higher risk of fluid overload events and haematoma expansion compared to 4F-PCC 5, 6
• Vitamin K administration may result in a slight decrease in PT-INR in critically ill patients with slightly prolonged PT-INR 3

Considerations for Treatment

When considering treatment options, the following points should be taken into account:

• The patient's specific condition and medical history should be considered when choosing a treatment option
• The potential risks and benefits of each treatment option should be weighed, including the risk of thromboembolic events and fluid overload events 5, 6
• The patient's INR levels and response to treatment should be closely monitored to ensure effective reversal of vitamin K antagonists and normalization of INR 4, 5, 6