Reversible coagulopathy associated with vitamin E excess

Vitamin E refers to a group of compounds that are essential to the diet of animals, where its primary function is an antioxidant. Excessive vitamin E supplementation can cause a reversible coagulopathy in the setting of compromised vitamin K absorption or function. We describe the case of a woman in her mid-80s treated for micronutrient deficiencies following a biliopancreatic diversion as a bariatric procedure 14 years previously. Her coagulation tests were normal until she commenced vitamin E and accidentally over-administered the prescribed dose. This resulted in a coagulopathy, characterised by a prolonged international normalised ratio (INR) and activated partial thromboplastin time (APTT). The patient never had any signs of active bleeding. Both coagulation parameters normalised after stopping the vitamin E and with vitamin K supplementation. This case signifies the importance of careful instruction and monitoring of vitamin replacement, in particular vitamin E supplementation, which in excess leads to coagulopathy.