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Vitamin K therapy in severe liver disease
R Mehta1, J J Reilly, R E Olson
1Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Summary
High-dose vitamin K (phylloquinone) did not improve clotting factors in a patient with liver disease. Despite extremely high levels, vitamin K therapy was ineffective and unnecessary.
Area of Science:
- Hepatology
- Hematology
- Clinical Pharmacology
Background:
- Parenchymatous liver disease can impair the synthesis of vitamin K-dependent clotting factors.
- Vitamin K (phylloquinone) is essential for the synthesis of these factors.
Observation:
- A patient with liver disease received high-dose intravenous phylloquinone (10 mg/d for 20 days).
- Despite treatment, synthesis of vitamin K-dependent factors did not improve.
- Plasma phylloquinone levels reached 300 times normal without affecting factors II, VII, IX, and X.
Findings:
- Intravenous high-dose phylloquinone was ineffective in improving vitamin K-dependent factor synthesis in this patient with parenchymatous liver disease.
- The patient exsanguinated during subsequent liver transplantation, suggesting a severe coagulopathy despite high vitamin K levels.
Implications:
- The case highlights a potential disconnect between administered vitamin K levels and functional factor synthesis in severe liver disease.
- Further vitamin K therapy was deemed unnecessary, suggesting alternative management strategies may be required.
- This case warrants further investigation into the efficacy of high-dose vitamin K in patients with advanced liver disease and impaired coagulation.