Evaluation and Survey of Intravenous Vitamin K 1 for Treatment of Coagulopathy in Critically Ill Patients

Study Objectives. To determine patient factors associated with coagulopathy, to assess variables affecting response to vitamin K 1 , to describe vitamin K 1 ‐associated adverse reactions, and to survey Canadian tertiary care hospitals about vitamin K 1 practice patterns in their intensive care units (ICUs). Design. Retrospective chart audit and prospective survey. Setting. Medical‐surgical ICU with a 23‐bed complement in a tertiary care, university‐affiliated hospital, and 47 Canadian tertiary care hospitals. Patients. Forty‐eight critically ill patients with nonconsumptive coagulopathies. Intervention. Intravenous vitamin K 1 utilization over 4 months. Measurements and Main Results. The only independent risk factor for elevated baseline international normalized ratios (INRs) was Acute Physiologic and Chronic Health Evaluation (APACHE) II score (r 2 = 0.51, p<0.05). The INR values decreased after two doses of vitamin K 1 10 mg for patients grouped as a whole (2.14 ± 0.96 to 1.61 ± 0.62, p<0.0001) and when patients were stratified according to APACHE II scores below 23 (1.83 ± 0.44 to 1.34 ± 0.18, p<0.05). The INRs were not significantly reduced for patients with APACHE II scores of 23 or greater (2.44 ± 1.23 to 1.82 ± 0.66). No variables were associated with response, and adverse events were not observed. Of 47 Canadian tertiary care hospitals surveyed, 27 (55%) responded. Twenty‐four (89%) indicated that vitamin K 1 was administered intravenously, and no adverse events resembling anaphylaxis were reported. Conclusion. Administration of two doses of intravenous vitamin K 1 10 mg was associated with reversal of coagulopathies, but variable responses may be expected for patients with high APACHE II scores. Randomized, placebo‐controlled studies are necessary to confirm the effectiveness of vitamin K 1 .