Vitamin K deficiency

Background

1. Cofactor for vitamin K-dependent clotting factors II, VII, IX, X
   1. Used by liver
   2. Fat soluble

Causes

1. Nutritional deficiency
2. Malabsorption
3. Cholestasis: since it is fat soluble and needs bile salts to be absorbed

Differential Diagnosis

Coagulopathy

Platelet Related

• Too few
  • Thrombocytopenia
• Nonfunctional
  • Aspirin
  • Von Willebrand disease

Factor Related

• Acquired (Drug Related)
  • Warfarin (Coumadin)
  • Unfractionated heparin
  • Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
  • Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
  • Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
• Illness induced
  • Vitamin K deficiency
  • Disseminated Intravascular Coagulation (DIC)
  • Liver disease induced coagulopathy
  • Uremic bleeding syndrome
• Genetic
  • Hemophilia
  • Factor VIII inhibitor
  • Lupus anticoagulant

Treatment

1. Fresh Frozen Plasma: 1ml contains 1U of each clotting factor
2. Consider Vitamin K oral or IV (subcutaneous not recommended): will take up to 24 hours to work and up to 2 weeks to wear off

See Also

• Warfarin (Coumadin) Reversal
• Coagulopathy (Main)