Indications for Vitamin K Administration
Vitamin K is indicated for coagulation disorders due to faulty formation of factors II, VII, IX, and X caused by vitamin K deficiency or interference with vitamin K activity, including anticoagulant-induced prothrombin deficiency, hemorrhagic disease of the newborn, and hypoprothrombinemia from various causes. 1
Specific Indications
Newborns and Infants
- All newborns should receive vitamin K prophylaxis at birth to prevent vitamin K deficiency bleeding (VKDB), which can occur in early, classic, and late forms 2, 3
- Exclusively breastfed infants require vitamin K supplementation as breast milk contains low levels of vitamin K 4
- Infants whose mothers have taken medications that interfere with vitamin K metabolism (anticonvulsants, anticoagulants, antituberculosis drugs) 4
- Infants with underlying diseases affecting vitamin K absorption such as cystic fibrosis, alpha-1-antitrypsin deficiency, or cholestasis 4
Cystic Fibrosis
- Vitamin K status is often suboptimal in people with CF, particularly those with CF-related liver disease 5
- Special attention should be paid to CF newborns, exclusively breastfed CF infants, and people with CF receiving broad spectrum antibiotic treatment, those with liver disease, or severe malabsorption 5
Anticoagulant Therapy
- Reversal of anticoagulant-induced prothrombin deficiency caused by coumarin or indanedione derivatives 1
- Patients on anticoagulant therapy require monitoring of coagulation parameters when vitamin K is administered 6
Malabsorption Conditions
- Hypoprothrombinemia secondary to factors limiting absorption or synthesis of vitamin K, including:
- Obstructive jaundice
- Biliary fistula
- Sprue
- Ulcerative colitis
- Celiac disease
- Intestinal resection
- Cystic fibrosis of the pancreas
- Regional enteritis 1
Drug-Induced Hypoprothrombinemia
- Conditions where interference with vitamin K metabolism is demonstrated, such as with salicylates 1
- Hypoprothrombinemia due to antibacterial therapy 1
Dosing Recommendations
Newborns
- For healthy newborns: 0.5-1.0 mg vitamin K1 intramuscularly within one hour of birth 6, 2
- Alternative oral regimen (if parents decline IM): 2.0 mg at birth, repeated at 2-4 and 6-8 weeks of age, with parents informed of increased VKDB risk 2, 3
- For preterm infants on parenteral nutrition: 10 μg/kg/day 4, 6
Children and Adults with Cystic Fibrosis
- Infants with CF: 0.3-1.0 mg/day of vitamin K1 5
- Older children and adults with CF: 1-10 mg/day of vitamin K1 depending on age 5
- Higher doses may be considered for those with low vitamin K levels or with higher risk factors such as long-term antibiotic use 5
Adults
- Adults on parenteral nutrition: 200 μg/day of vitamin K1 6
- For most indications: 2.5-10 mg, with up to 25-50 mg for severe cases 6
Administration Routes and Timing
- Intramuscular administration is the preferred route for newborns 5, 2
- Maximum effect for IV administration occurs within 6-12 hours 5, 6
- Oral supplementation takes about 24 hours to reach full effect 5, 6
- Daily administration is preferred for patients with CF because of the low storage capacity of vitamin K 5
Monitoring
- Classical coagulation tests (PT, PTT) can be used in low-risk infants for indirect evaluation of vitamin K status 4
- Undercarboxylated Serum Vitamin K-Dependent Proteins (PIVKA-II) are more useful biomarkers of subclinical vitamin K deficiency for at-risk patient groups 4
- For patients with CF, vitamin K status should be monitored regularly 5
Special Considerations
- Vitamin K1 (phytomenadione, phylloquinone) is recommended as the safest form of supplementation 5
- Vitamin K toxicity (phylloquinone) is not a concern, as there are no known adverse effects of supplementation 5, 4
- Rare anaphylactoid reactions with bronchospasm and cardiac arrest after IV vitamin K1 administration have been reported 5
- Continuous enteral nutrition should be withheld for 1 hour before and after anticoagulant drugs administration to prevent interactions 5