title: Supplemental vitamin K improves the stability of anticoagulation in a patient with low tissue stores of vitamin K secondary to coeliac disease.
abstract: Maintenance of a patient's international normalised ratio (INR) within the appropriate target range remains a challenge in clinical practice. The effects of concurrent medication, alcohol and compliance on stable control are well documented. Recent evidence also shows that supplemental vitamin K in patients with low body stores improves the stability of INR in these patients. Here, the case of a 57-year-old with coeliac disease requiring warfarin for a metallic mitral valve, who had poor INR stability resulting in thrombotic and bleeding complications, is described. Her vitamin K body stores were extremely low. Supplementation of vitamin K (100 μg daily) resulted in improvement in anticoagulation stability (mean (SD) 3.41 (1.68) vs 4.68 (3.34)). The percentage time spent within target INR range doubled following vitamin K supplementation. This case illustrates a relatively new approach to managing patients with highly unstable INR levels and provides extra understanding of factors influencing INR stability.
authors.affiliation: St Vincents Hospital, Geriatrics, Elm Park, Dublin, D4, Ireland.
authors.forename: Cassandra Emily
authors.initials: CE
authors.lastname: Janeczko
authors.forename: Karen
authors.initials: K
authors.lastname: Sweeney
authors.forename: G
authors.initials: G
authors.lastname: Connaghan