How is vitamin K (Vit K) administered in a patient with liver dysfunction?

From the Guidelines

Vitamin K administration in patients with liver dysfunction should be done intravenously at a dose of 5-10 mg, as this is the most effective route for rapid correction of coagulopathy, as recommended by the most recent and highest quality study 1. When administering vitamin K to patients with liver problems, it is crucial to consider the severity of the condition and the urgency of correction.

• For mild deficiency, oral vitamin K (phytonadione) at 2.5-10 mg daily can be used.
• In more urgent situations, such as coagulopathy with active bleeding, intravenous vitamin K at 5-10 mg slow infusion over 20-30 minutes is recommended.
• For moderate cases, subcutaneous administration at 5-10 mg can be used. It's essential to monitor prothrombin time and INR before and after administration to assess response.
• Patients with severe liver disease may have limited response to vitamin K due to reduced hepatic synthesis of clotting factors, not just vitamin K deficiency.
• The response to vitamin K can help differentiate between liver dysfunction and simple vitamin K deficiency.
• Intravenous administration carries a small risk of anaphylactoid reactions, so slow infusion is essential, as noted in 1. Treatment may need to be repeated daily for several days in patients with ongoing liver problems to maintain adequate coagulation.
• The use of prothrombin complex concentrates (PCCs) in combination with vitamin K may be considered in certain situations, but the evidence for its use in patients with liver disease is limited, as discussed in 1.
• The administration of PCCs to patients with liver disease may increase the risk of thromboembolic events, and therefore, its use should be carefully considered, as warned in 1.

From the FDA Drug Label

Repeated large doses of vitamin K are not warranted in liver disease if the response to initial use of the vitamin is unsatisfactory. The administration of vitamin K in a patient with liver dysfunction should be done with caution.

• Dosage should be kept as low as possible.
• Prothrombin time should be checked regularly as clinical conditions indicate.
• Repeated large doses of vitamin K are not recommended if the initial response is unsatisfactory, as it may indicate the condition is unresponsive to vitamin K 2.

From the Research

Administration of Vitamin K in Liver Dysfunction

• Vitamin K may be administered to patients with liver disease, particularly those with increased prothrombin time due to vitamin K deficiency, malnutrition, or cholestatic liver disease 3.
• However, studies have shown that vitamin K administration may not significantly improve coagulation parameters in patients with liver disease 4, 5.
• In patients with severe coagulopathy, other therapies such as fresh frozen plasma infusion, plasma exchange, or cryoprecipitate therapy may be more effective 3, 6.
• High-dose intravenous vitamin K administration has been evaluated, but its effectiveness is limited, and factors associated with response include lower body weight, absence of cirrhosis, and lower bilirubin 7.

Routes of Administration

• Vitamin K can be administered subcutaneously, as seen in a study where a single dose of 10 mg of vitamin K1 was administered to patients with liver disease 4.
• Intravenous administration of high-dose vitamin K has also been evaluated, but its effectiveness is limited 7.

Efficacy and Safety

• The efficacy of vitamin K in correcting coagulopathy in patients with liver disease is controversial, with limited evidence supporting its use 4, 5.
• The safety of vitamin K administration has been evaluated, with a low incidence of safety events observed 7.
• However, the administration of vitamin K for INR correction in critically ill patients with coagulopathy secondary to liver disease was not associated with a lower odds of new bleeding events 5.