Appropriateness of using vitamin K for the correction of INR elevation secondary to hepatic disease in critically ill patients: An Observational Study [post]

Khalid Al Sulaiman, Mashael Al Mutairi, Omar Al Harbi, Alanoud Al Duraihim, Sara Aldosary, Haifa Al Khalil, Abdulrahman Al Shaya, Shmeylan Al Harbi, Nouf Alotaibi, Kholoud Al Aamer, Ramesh Vishwakarma, Abdulmalik Al Katheri (+1 others)
2021 unpublished
Background: Hepatic diseases have been associated with an increased risk of coagulopathy and increased odds of secondary thrombosis and bleeding. Using vitamin K for correction of coagulopathy in critically ill patients is controversial with limited evidence.Objective: To evaluate the efficacy as well as safety of vitamin K in correction of international normalized ratio (INR) elevation secondary to liver disease in critically ill patients.Setting: Tertiary teaching hospital in Saudi
more » ... in Saudi Arabia.Method: A retrospective case-control study of adult ICU patients with coagulopathy secondary to liver disease. A total of 98 patients were included in the study. Patients were divided into two groups based on vitamin K administration to correct INR elevation. differences. The propensity score was generated based on disease severity scores to adjust group.Main outcomes: The primary outcome was to evaluate the association between vitamin K administration and the incidence of new bleeding events in critically ill patients with INR elevation secondary to liver disease. Secondary outcomes were to evaluate the incidence of a new thrombotic event and the degree of INR correction with vitamin K. Results: Forty-seven patients (48%) received vitamin K during the study period. The incidence of the new bleeding event was not statistically different between groups (OR 2.4, 95% CI 0.28-21.67, P=0.42). Delta of INR reduction was observed with a median of 0.63 when the first dose is given (p-value: <.0001). However, other subsequent doses of vitamin K were not statistically significant.Conclusion: Using vitamin K for INR correction in critically ill patients with coagulopathy secondary to liver disease was not associated with a lower incidence of new bleeding events. Vitamin K was efficient in reducing INR level at the first dose, other subsequent doses were not.Impacts on practice: 1. Routine use of vitamin K to correct PT/INR in critically ill patients with liver disease may need be re-evaluated.2. If the initial dose of vitamin K does not reverse INR elevation, subsequent doses may not have any effect.3. Using vitamin K to correct INR was not associated with a lower incidence of new bleeding events nor RBCs/Platelets transfusion than patients who did not receive it.
doi:10.21203/rs.3.rs-623623/v2 fatcat:2gejwyacknc7jlpayhfuc4wr6i