vitamin-k-1 and Cerebral-Hemorrhage

To determine the effect of maternal antenatal administration of vitamin K1 on activity level of vitamin K-dependent coagulation factors and on the occurrence of periventricular-intraventricular hemorrhage (PIVH).. This study was conducted on 90 infants who were classified into; Group A: 30 preterm whose mothers received antenatal vitamin K1, Group B: 30 preterm whose mothers did not receive antenatal vitamin K1, and Group C: 30 healthy full term newborns as a control group. All newborns were subjected to measurement of the activity level of vitamin K-dependent coagulation factors (FII, FVII, FIX and FX). Cranial ultrasound was done on the 1st, 3rd and 7th days of life.. Group B showed significantly lower activity level of FII and FX with higher incidence of PIVH compared with group A. Neonates who developed PIVH by the 7th day in both group A and B had significantly lower activity level of vitamin K-dependent coagulation factors.. when antenatal vitamin K1 was given to pregnant women at imminent risk of preterm labor, their preterm neonates were able to achieve a clotting status approaching that of full term neonates and are less liable to develop PIVH.

Topics: Antifibrinolytic Agents; Blood Coagulation Factors; Cerebral Hemorrhage; Delivery, Obstetric; Egypt; Female; Fetal Blood; Humans; Incidence; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Pregnancy; Prenatal Exposure Delayed Effects; Vitamin K 1

Infants less than 35 weeks' gestation age are susceptible to periventricular-intraventricular hemorrhage (PIVH). This may be partially attributable to low concentrations of vitamin K-dependent coagulation factors. The purposes of this study were: (1) to determine the umbilical blood activity levels of vitamin K-dependent coagulation factors II, VII, IX and X; (2) to investigate the change in activities of these factors in premature infants' umbilical blood after prenatal administration of vitamin K1 to the mothers; and (3) to study the prophylactic effects on PIVH after maternal antenatal supplemental vitamin K1.. Pregnant women in preterm labor at less than 35 weeks of gestation were randomly selected to receive antenatal vitamin K1 10 mg per day injection intramuscularly or intravenously for 2-7 days (vitamin K1 group, n = 40), or no such treatment (control group, n = 50). At the same period, cord blood samples were collected from thirty full-term neonates to compare the factor levels with those of premature infants. Intracranial ultrasound was performed by the same sonographer to determine the presence and severity of PIVH.. The activities of vitamin K-dependent coagulation factors in umbilical blood in the control group were: factor II 25.64+/-9.49%, factor VII 59.00+/-17.66%, factor IX 24.67+/-8.88%, and factor X 30.16+/-5.02%. In full-term infants, the respective values were: factor II 36.70+/-4.88%, factor VII 64.54+/-10.62%, factor IX 30.18+/-5.69%, and factor X 34.32+/-12.63%. In vitamin K1 group these factors were: factor II 36.35+/-6.88%, factor VII 69.59+/-16.55%, factor IX 25.71+/-10.88%, and factor X 39.26+/-8.02%. The data suggest the absence of vitamin K-dependent coagulation factors in preterm infants, and antenatal supplement of vitamin K1 may increase the cord blood activity of factor II, VII and factor X (P < 0.001). In addition, the overall rates of PIVH in the vitamin K1 group and in controls were 32.4 and 52.0%, respectively (P = 0.036), and the frequency of severe PIVH was 5.0 and 20.0%, respectively (P = 0.038).. Administration of vitamin K1 to pregnant women at less than 35 weeks' gestation age may result in improved coagulation and may reduce the incidence as well as the severity degree of PIVH.

Topics: Blood Coagulation Factors; Cerebral Hemorrhage; Female; Fetal Blood; Fetal Therapies; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Pregnancy; Vitamin K 1

We prospectively evaluated whether combined antenatal corticosteroid and vitamin K administration have any benefit, over and above that of corticosteroid or vitamin K used alone, in reducing the frequency and the degree of PIVH in premature newborns less than 35 weeks' gestation. All of these 280 pregnant women were randomly allocated into five groups according to the in-patient sequence. Group A (vitamin K1 group) including 38 pregnant women (40 newborns) received antenatal intramuscular or intravenously injection of vitamin K1 10 mg per day for 2-7 days. Group B (single dose corticosteroid group) including 57 pregnant women (63 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 1 day. Group C (two dose corticosteroid group) including 62 pregnant women (70 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 2 days. Group D (combined using dexamethasone and vitamin K1) including 41 pregnant women (44 newborns) received dexamethasone 10 mg per day for 1 day and vitamin K110 mg per day for 2-7 days. Control group, including 82 pregnant women (87 newborns) were received neither dexamethasone nor vitamin K1 injection. The results showed PIVH was diagnosed in 17 of 40 (42.5%) in Group A, 34 of 63 (54.0%) in Group B, 36 of 70 (51.4%) in Group C, 14 of 44 (31.8%) in Group D, and 57 of 87 (65.2%) in control infants (p = 0.004). More infants in the control group had grade III or IV intracranial hemorrhage after birth (p = 0.049). After antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly. The total and severe incidence of PIVH in Group B (single doses dexamethasone) and Group C (two courses dexamethasone) there were no significant difference. It showed that after antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly, and combined antenatal corticosteroid and vitamin K administration have much benefit, over and above that of corticosteroid or vitamin K used alone.

Topics: Blood Coagulation Factors; Cerebral Hemorrhage; Dexamethasone; Female; Fetal Blood; Fetal Therapies; Glucocorticoids; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Pregnancy; Prenatal Care; Prospective Studies; Vitamin K 1

Infants less than 35 weeks of gestational age are susceptible to peri-/intraventricular hemorrhage (PIVH). This may be due in part to low concentrations of vitamin K-dependent coagulation factors. This study was conducted to determine the umbilical cord blood activities of vitamin K-dependent coagulation factors II, VII, IX and X in premature infants to understand whether preterm infants have absence status of these factors the changes of theses factors' activities in premature infants' umbilical blood after vitamin K(1) was given to mothers antenatally and the preventing effectiveness of PIVH after maternal antenatal supplement of vitamin K(1).. Pregnant women in preterm labor at less than 35 weeks of gestational age were randomly selected to receive antenatal vitamin K(1) intramuscular or intravenous injections 10 mg per day for 2 to 7 days (vitamin K(1) group), or no vitamin K(1) treatment (control group). Dexamethone was antenatally given to both groups of pregnant women routinely. Vitamin K(1) group had 44 infants and the control group had 133 infants. During the same period, thirty full-term neonates' cord blood samples were obtained to determine theses factors to compare with those from the premature infants. The cranial ultrasound was performed by a same physician to understand whether the neonates were complicated with PIVH and its severity.. The levels of vitamin K-dependent coagulation factors in umbilical blood in control group were significantly lower than those in full-term infants' cord blood (P < 0.05). However, in vitamin K(1) group, supplement of vitamin K(1) antenatally could significantly increase activities of factors II, VII and X in preterm infants' cord blood (P < 0.05). The total occurrence rates of PIVH in vitamin K(1) group and control group were 31.8% and 52.6%, respectively, (P = 0.017), and the frequency of severe PIVH in vitamin K(1) group and control group was 2.3% and 12.0%, respectively (P = 0.057).. Preterm infants have absence status of vitamin K-dependent coagulation factors. Administration of vitamin K(1) to pregnant women at less than 35 weeks of gestational age resulted in significantly improved activities of vitamin K-dependent coagulation factors II, VII, and X, and a significantly decreased frequency of PIVH and less severe hemorrhage in preterm infants.

Topics: Blood Coagulation Factors; Cerebral Hemorrhage; Female; Fetal Blood; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Pregnancy; Vitamin K 1

Intracerebral hemorrhage (ICH) is a life-threatening complication of oral anticoagulant therapy that sometimes results in hematoma expansion after onset. Our facility did not have a standardized process for treating oral anticoagulant-associated ICH; this resulted in lag times from order to reversal agent administration.. The aim of this study was to examine the impact of a rapid anticoagulant reversal protocol, combined with warfarin and direct-acting oral anticoagulant therapy, in decreasing door to first intervention times.. This study used a retrospective quality assessment research approach in examining an oral anticoagulant reversal protocol to compare the control and intervention groups. Phytonadione was the first intervention treatment for most study participants diagnosed with warfarin-associated ICH with an international normalized ratio greater than 1.4. Factor IX was the first intervention treatment for all but one study participant with DOAC-associated ICH.. Findings were statistically significant (P < .05) for door to first intervention treatments. Door to phytonadione in minutes decreased from 232.7 (SD, 199.4) to posttest findings of 111.4 (SD, 64.6). Door to factor IX in minutes decreased from 183.9 (SD, 230.2) to posttest findings of 116.6 (SD, 69.1).. Study findings support the hypothesis that the new protocol was associated with lower door-to-treatment times for eligible patients.

Topics: Administration, Oral; Aged; Anticoagulants; Antifibrinolytic Agents; Cerebral Hemorrhage; Clinical Protocols; Factor IX; Female; Humans; Male; Retrospective Studies; Time Factors; Vitamin K 1; Warfarin

We report on 2 cases associating retinal (RH) and cerebral hemorrhages (CH), which first suggested the diagnosis of shaken baby syndrome (SBS). After an etiologic search, the diagnosis was corrected: the first case was a late hemorrhagic disease of the newborn and the second case hemophilia A. RH is a major feature of SBS, although not pathognomonic. There is no specific RH of SBS but they usually affect the posterior retinal pole. Typically, RHs of SBS are present in both eyes, although unilateral RHs do not exclude the diagnosis of SBS. The relationship between RH and CH has been reported in SBS but also in other diseases. Thus, one must search for hemostasis abnormalities, even though the clinical presentation suggests SBS. Ignoring SBS as well as coming to the conclusion of SBS too quickly should be avoided. Diagnostic difficulties may be related to the number of physicians involved and their interpretation of the facts. These 2 cases underline the need for working as a team that includes hematologists able to interpret coagulation parameters.

Topics: Antifibrinolytic Agents; Cerebral Hemorrhage; Coagulants; Consanguinity; Diagnosis, Differential; Factor VIII; Fatal Outcome; Hematoma, Subdural; Hemophilia A; Humans; Infant; Infant, Newborn; Male; Retinal Hemorrhage; Risk Factors; Shaken Baby Syndrome; Vitamin K 1; Vitamin K Deficiency Bleeding

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.

Topics: Aged; Anticoagulants; Cerebral Hemorrhage; Drug Interactions; Drugs, Chinese Herbal; Hematoma; Humans; Male; Treatment Outcome; Vitamin K 1; Warfarin

Topics: Breast Feeding; Cerebral Hemorrhage; Cholestasis; Exchange Transfusion, Whole Blood; Female; Humans; Infant; Male; Vitamin K 1; Vitamin K Deficiency

Topics: Cerebral Hemorrhage; Female; Humans; Infant, Newborn; Time Factors; Vitamin K; Vitamin K 1; Vitamin K Deficiency; Vitamin K Deficiency Bleeding

Pregnant Sprague-Dawley rats were given daily oral doses of sodium warfarin (100 mg/kg) and concurrent intramuscular injections of vitamin K1 (10 mg/kg). This dosing regimen did not have any apparent deleterious effect on the dams and did not affect the fetuses when administered from day 1 to day 12 of pregnancy. However, similar treatment from day 9 to 20 caused hemorrhage in the fetuses examined on day 21 of gestation. There were no hemorrhages in the control fetuses from dams receiving vitamin K1 only. The lowest effective dose of warfarin, in conjunction with daily doses of vitamin K1, was 3 mg/kg. This dose caused hemorrhage in 28% of fetuses; the incidence of affected fetuses was not further increased by doses of warfarin up to 100 mg/kg. Hemorrhages affected the fetal brain, face, eyes, and ear and occasionally the limbs. Brain hemorrhages were frequently intraventricular and caused various degrees of hydrocephaly. Bony defects were not a feature of prenatal exposure to warfarin. These results show that prenatal exposure of the rat to warfarin and vitamin K duplicates the hemorrhagic abnormalities and pathology associated with prenatal exposure to warfarin in the human. It did not induce bony or facial defects probably because the vitamin K-dependent components of bone development occur postnatally in the rat. This model should allow detailed determination of the role of vitamin K-dependent proteins in development.

Topics: Animals; Bone and Bones; Cerebral Hemorrhage; Female; Fetal Diseases; Maternal-Fetal Exchange; Pregnancy; Rats; Rats, Inbred Strains; Teratogens; Vitamin K 1; Warfarin

Topics: Cerebral Angiography; Cerebral Hemorrhage; Humans; Intracranial Aneurysm; Male; Middle Aged; Rupture; Vitamin K 1; Warfarin