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For further information, see CMDT Part 16-09: Acquired Disorders of Coagulation

KEY FEATURES

  • May occur as a result of

    • Deficient dietary intake (eg, green leafy vegetables and soybeans)

    • Malabsorption

    • Decreased production by intestinal bacteria (due to treatment with chemotherapy or antibiotics)

  • Vitamin K is required for normal function of vitamin K epoxide reductase that assists in posttranslational gamma-carboxylation of the coagulation factors II, VII, IX, and X, which is necessary for their activity

  • Risk of developing vitamin K deficiency is high in hospitalized patients taking broad-spectrum antibiotics who have poor or no oral intake

CLINICAL FINDINGS

  • Hospitalized patients on broad-spectrum antibiotics and with poor or no oral intake are at high risk for vitamin K deficiency

DIAGNOSIS

  • Mild to moderate vitamin K deficiency typically features a prolonged prothrombin time (PT)

  • Severe vitamin D deficiency: prolonged activated partial thromboplastin time (aPTT)

  • Activity levels of individual clotting factors II, VII, IX, and X typically are low

  • Concomitant low factor V activity level not indicative of isolated vitamin K deficiency but may indicate an underlying defect in liver synthetic function

TREATMENT

  • Vitamin K1 (phytonadione) may be administered via oral or intravenous routes; the subcutaneous route is not recommended due to erratic absorption

  • Oral administration

    • Absorption is typically excellent

    • Partial improvement in PT should be seen within 18–24 hours

    • Dosage: 5–10 mg/day

  • Intravenous administration

    • Results in faster normalization of a prolonged PT than oral administration

    • Parenteral doses should be administered slowly (eg, over 30 minutes) with concomitant monitoring due to infrequent reported serious adverse reactions

    • Dosage: 2–10 mg (often)

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