vitamin-k-1 and Liver-Cirrhosis

Essential to the coagulation pathway, vitamin K (phytonadione) is used to correct clotting factor deficiencies and for reversal of warfarin-induced bleeding. In practice, high-dose intravenous (IV) vitamin K is often used, despite limited evidence supporting repeated dosing.. This study sought to characterize differences in responders and nonresponders to high-dose vitamin K to guide dosing strategies.. This was a case-control study of hospitalized adults who received vitamin K 10 mg IV daily for 3 days. Cases were represented by patients who responded to the first dose of IV vitamin K and controls were nonresponders. The primary outcome was change in international normalized ratio (INR) over time with subsequent vitamin K doses. Secondary outcomes included factors associated with response to vitamin K and incidence of safety events. The Cleveland Clinic Institutional Review Board approved this study.. There were 497 patients included, and 182 were responders. Most patients had underlying cirrhosis (91.5%). In responders, the INR decreased from 1.89 at baseline (95% CI = [1.74-2.04]) to 1.40 on day 3 (95% CI = [1.30-1.50]). In nonresponders, the INR decreased from 1.97 (95% CI = [1.83-2.13]) to 1.85 ([1.72-1.99]). Factors associated with response included lower body weight, absence of cirrhosis, and lower bilirubin. There was a low incidence of safety events observed.. In this study of mainly patients with cirrhosis, the overall adjusted decrease in INR over 3 days was 0.3, which may have minimal clinical impact. Additional studies are needed to identify populations who may benefit from repeated daily doses of high-dose IV vitamin K.

Topics: Adult; Anticoagulants; Blood Coagulation; Case-Control Studies; Humans; International Normalized Ratio; Liver Cirrhosis; Vitamin K; Vitamin K 1; Warfarin

Vitamin K1 is used as a liver protection drug for cholestasis-induced liver fibrosis in China, but the mechanism of vitamin K1's action in liver fibrosis is unclear. In this study, a model of liver fibrosis was achieved via bile duct ligation in rats. The rats were then injected with vitamin K1, and the levels of serum aspartate aminotransferase, alanine transaminase, total bilirubin and the fibrotic grade score, collagen content, the expressions of α-smooth muscle actin (SMA) and cytokeratin 19 (CK19) were measured on day 28 after ligation. The levels of the biochemical parameters, fibrotic score and collagen content were significantly reduced by treatment with vitamin K1 in bile duct-ligated rats. In addition, α-SMA and CK19 expression was significantly reduced by vitamin K1 treatment in bile duct-ligated rats. These results suggested that vitamin K1 may attenuate liver fibrosis by inhibiting hepatic stellate cell activation in bile duct-ligated rats.

Topics: Actins; Alanine Transaminase; Animals; Aspartate Aminotransferases; Bile Ducts; Bilirubin; Collagen; Disease Models, Animal; Keratin-19; Ligation; Liver; Liver Cirrhosis; Male; Protective Agents; Rats; Rats, Sprague-Dawley; Vitamin K 1

Topics: Chromatography, High Pressure Liquid; Hepatitis, Chronic; Humans; Indicators and Reagents; Liver; Liver Cirrhosis; Reference Values; Vitamin K; Vitamin K 1

The high incidence of consumption coagulopathy in active liver cirrhosis prompted us to introduce low-dosage heparin therapy (LDHT) in the management of this condition. An investigation was carried out on 109 patients with clinical and biochemical evidence of progressive liver cirrhosis, which was designed to evaluate whether in addition to basic LDHT, the administration of either vitamin K1, human fibrinogen or partial prothrombin complex (Prothromplex 500) enhanced the results obtained with LDHT alone. The normotest, PTT, thrombin coagulase activity, fibrinogen and platelet count were determined at regular intervals. A significant increase in fibrinogen and platelet count was obtained within 14 days of LDHT in about 75% of the patients and the consumption coagulopathy was halted. Additional treatment with vitamin K1 did not bring about any further increase in the prothrombin complex. Substitution therapy with factors II, IX, X and fibrinogen combined with LDHT brought the expected results. The results reported in the literature and the aims of, and indications for LDHT are discussed.

Topics: Blood Coagulation Factors; Disseminated Intravascular Coagulation; Heparin; Humans; Liver Cirrhosis; Vitamin K 1

Factor VII levels have been measured in 100 patients with liver disease following parenteral vitamin K1 therapy. There was good agreement between specific factor VII measurements and the one-stage prothrombin time apart from six patients with compensated cirrhosis in whom the prothrombin time was prolonged despite the presence of normal factor VII levels. A mean activity of 58% was found in patients with cirrhosis. Cirrhotic patients with features of hepatic decompensation had a significantly lower mean level of activity (40%) than the "contrast" patients with surgical obstruction of the major bile ducts (93%). Patients with chronic active liver disease had moderate depression of factor VII levels and those with non-cirrhotic liver damage had mean activities similar to the contrast group. Factor VII levels could not be correlated with BSP retention but there was a correlation with serum albumin concentration. It is concluded that the prothrombin time using Quick test with a standardized thromboplastin showing good sensitivity to factor VII, eg, the Manchester reagent (BCT), provides a reliable index of coagulability in chronic liver disease, and specific factor VII assays are not indicated.

Topics: Cholestasis; Chronic Disease; Factor VII; Humans; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Prothrombin Time; Vitamin K 1

Topics: Acute Disease; Alanine Transaminase; Aspartate Aminotransferases; Bilirubin; Blood Cell Count; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Factor IX; Factor V; Factor VII; Factor X; Factor XIII; Female; Fibrinogen; Heparin; Humans; Liver Cirrhosis; Male; Methods; Prothrombin; Serum Globulins; Solubility; Vitamin K 1

Topics: Buttocks; Erythema; Female; Humans; Injections, Intramuscular; Liver Cirrhosis; Male; Microscopy, Electron; Middle Aged; Scleroderma, Localized; Skin; Vitamin K 1

Topics: Blood Cell Count; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Gastrointestinal Hemorrhage; Hemorrhage; Hemostasis; Humans; Liver Cirrhosis; Liver Function Tests; Menorrhagia; Prothrombin Time; Vitamin K 1

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Heart Diseases; Hepatitis A; Humans; Hypersplenism; Liver Cirrhosis; Liver Extracts; Lung Diseases; Middle Aged; Vitamin B 12; Vitamin E; Vitamin K 1

Topics: Alcoholism; Antifibrinolytic Agents; Bilirubin; Blood; Drug Therapy; Hematologic Tests; Humans; Infusions, Parenteral; Liver Cirrhosis; Liver Cirrhosis, Alcoholic; Liver Function Tests; Prothrombin; Serum Albumin; Vitamin K; Vitamin K 1; Vitamins

Topics: Anemia; Anemia, Aplastic; Anemia, Hemolytic; Anticoagulants; Blood Coagulation; Chemical and Drug Induced Liver Injury; Cholecystitis; Coronary Disease; Dietary Fats; Factor VIII; Globulins; Hemophilia A; Hepatitis; Hypertension; Intracranial Embolism; Intracranial Embolism and Thrombosis; Jaundice; Jaundice, Chronic Idiopathic; Jaundice, Obstructive; Leukemia; Liver Cirrhosis; Liver Neoplasms; Myocardial Infarction; Purpura; Rabbits; Research; Toxicology; Vitamin K 1

Topics: Humans; Hypoprothrombinemias; Liver Cirrhosis; Nutrition Therapy; Prothrombin; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Humans; Hypoprothrombinemias; Liver Cirrhosis; Naphthoquinones; Prothrombin; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Heparin Antagonists; Humans; Hypoprothrombinemias; Liver Cirrhosis; Naphthoquinones; Prothrombin; Vitamin K; Vitamin K 1

Topics: Antifibrinolytic Agents; Factor Xa; Humans; Jaundice; Jaundice, Obstructive; Liver Cirrhosis; Naphthoquinones; Vitamin K; Vitamin K 1