Evaluation and survey of intravenous vitamin K1 for treatment of coagulopathy in critically ill patients.
OBJECTIVE
To determine patient factors associated with coagulopathy, to assess variables affecting response to vitamin K1, to describe vitamin K1-associated adverse reactions, and to survey Canadian tertiary care hospitals about vitamin K1 practice patterns in their intensive care units (ICUs).


METHODS
Retrospective chart audit and prospective survey.


METHODS
Medical-surgical ICU with a 23-bed complement in a tertiary care, university-affiliated hospital, and 47 Canadian tertiary care hospitals.


METHODS
Forty-eight critically ill patients with nonconsumptive coagulopathies.


METHODS
Intravenous vitamin K1 utilization over 4 months.


RESULTS
The only independent risk factor for elevated baseline international normalized ratios (INRs) was Acute Physiologic and Chronic Health Evaluation (APACHE) II score (r2 = 0.51, p<0.05). The INR values decreased after two doses of vitamin K1 10 mg for patients grouped as a whole (2.14 +/- 0.96 to 1.61 +/- 0.62, p<0.0001) and when patients were stratified according to APACHE II scores below 23 (1.83 +/- 0.44 to 1.34 +/- 0.18, p<0.05). The INRs were not significantly reduced for patients with APACHE II scores of 23 or greater (2.44 +/- 1.23 to 1.82 +/- 0.66). No variables were associated with response, and adverse events were not observed. Of 47 Canadian tertiary care hospitals surveyed, 27 (55%) responded. Twenty-four (89%) indicated that vitamin K1 was administered intravenously, and no adverse events resembling anaphylaxis were reported.


CONCLUSIONS
Administration of two doses of intravenous vitamin K1 10 mg was associated with reversal of coagulopathies, but variable responses may be expected for patients with high APACHE II scores. Randomized, placebo-controlled studies are necessary to confirm the effectiveness of vitamin K1.
MacLaren
R
R
School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262, USA.
Wilson
S J
SJ
Campbell
A
A
Anderson
D
D
Rocker
G
G
D018806:APACHE; D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000097:blood*; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D003625:Data Collection; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D010837:Vitamin K 1 / Q000008:administration & dosage / Q000097:blood*
D000933:Antifibrinolytic Agents; D010837:Vitamin K 1