Introduction: Coagulopathy in cirrhosis is characterized by an increased risk of both bleeding and thrombosis due to impaired synthetic function of the liver. Despite limited evidence, vitamin K is often given to patients with cirrhosis and an elevated INR to reduce perceived bleeding risk. This study aimed to evaluate if three days of oral vitamin K significantly reduces INR in this population. Methods: This retrospective study evaluated adults admitted to the medical ICU or general medicine service from 2022-2024. Patients were included if they had cirrhosis, a baseline INR ≥1.5, and received oral vitamin K for at least three consecutive days. Exclusion criteria included intravenous vitamin K administration, multiple oral doses in one day, concomitant therapeutic anticoagulation, and active bleeding at baseline. The primary endpoint was change in INR from baseline to day three. Secondary endpoints included INR changes after each dose and thrombotic or bleeding events within seven days. Data were collected by chart review and analyzed with descriptive statistics, Wilcoxon signed-rank tests, and Mann-Whitney U tests. Results: A total of 75 patients were included. The median INR was 2.80 (IQR 2.20–3.40) at baseline and 2.30 (IQR 1.90–2.90) on day three. The median INR change was -0.20 (IQR -0.50–0.00; p< 0.001). Sixteen patients (21.3%) had an increase in INR from baseline to day three. Bleeding events occurred in twelve patients (16.0%), and one (1.3%) had a thrombotic event. Patients who experienced bleeding had a higher baseline INR (3.15 vs. 2.70; p=0.107) and greater INR decrease (-0.55 vs -0.20; p=0.032) compared to those who did not. Critically ill patients had a higher baseline INR (3.00 vs. 2.70; p=0.117) and slightly greater INR reduction (-0.30 vs. -0.20; p=0.562) than medicine patients. Conclusions: Three days of oral vitamin K was associated with a statistically significant INR decrease. The clinical relevance is unclear, as the magnitude of change was small and many patients had an increased INR despite therapy. Bleeding was more common in patients with higher baseline INRs and greater INR reductions, suggesting limited clinical benefit. These findings question the routine use of oral vitamin K in cirrhosis and highlight the need for better strategies to assess and manage bleeding risk.
Newman et al. (Sun,) studied this question.