title: Impact of Vitamin K Administration on INR Changes and Bleeding Events Among Patients With Cirrhosis.
abstract: BACKGROUND
  The efficacy of vitamin K in lowering an elevated INR in the setting of cirrhosis is not well established.
  
  
  OBJECTIVE
  The purpose of this investigation is to determine the effect of vitamin K administration on the INR and bleeding eventsamong hospitalized patients with cirrhosis.
  
  
  METHODS
  This is a retrospective investigation of patients hospitalized at an academic institution from 2010 to 2012. Adults with an ICD9 code supporting cirrhosis were segregated into matched cohorts based on provision of vitamin K. Multivariable logistic regression of factors associated with INR decrease and bleeding events was completed.
  
  
  RESULTS
  The final matched cohort (n = 276) contained 130 patients who received vitamin K and 146 who did not receive this therapy. ICU care (adjusted odds ratio [AOR] = 2.91; 95% CI = 1.54-5.49; P = 0.01), receipt of a blood product (AOR = 2.40; 95%CI = 1.35-4.24; P = 0.03), and baseline INR > 1.6 (AOR = 1.72; 95% CI = 1.00-2.95; P = 0.05), but not vitamin K administration (AOR = 1.17; 95% CI = 0.66-2.08; P = 0.59), were associated with INR decrease. Bleeding events occurred more frequently among patients with a history of esophageal varices (AOR = 6.35; 95% CI = 1.21-33.4; P = 0.03), but vitamin K administration did not have an impact on these events (AOR = 4.90; 95% CI = 0.56-43.0; P = 0.15).
  
  
  CONCLUSIONS
  Administration of vitamin K did not affect INR changes or bleeding events in this cohort of hospitalized patients with cirrhosis.
authors.affiliation: Washington University in St Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Adam V
authors.initials: AV
authors.lastname: Meyer
authors.affiliation: St Louis College of Pharmacy, St. Louis, MO, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Green
authors.affiliation: Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Pautler
authors.affiliation: Washington University in St Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Korenblat
authors.affiliation: Barnes-Jewish Hospital, St. Louis, MO, USA end0164@bjc.org.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Deal
authors.affiliation: Washington University in St Louis School of Medicine, St. Louis, MO, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Thoelke
mesh_terms: D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014812:Vitamin K / Q000008:administration & dosage*
chemical_list: D000933:Antifibrinolytic Agents; D014812:Vitamin K
keywords: bleeding events; cirrhosis; coagulopathy; liver disease; vitamin K