Novel treatment (new drug/intervention; established drug/procedure in new situation)
Supplemental vitamin K improves the stability of anticoagulation in a patient with low tissue stores of vitamin K secondary to coeliac disease
1 St Vincents Hospital, Geriatrics, Elm Park, Dublin, D4, Ireland
2 St Michaels Hospital, Lower Georges St, Dun Laoghaire, Dublin, Ireland
3 St Michaels Hospital, Haematology, Lower Georges St, Dun Laoghaire, Dublin, Ireland
Correspondence to:
Cassandra Emily Janeczko, cejaneczko{at}hotmail.com
Maintenance of a patient’s international normalised ratio (INR) within the appropriate target range remains a challenge in clinical practice. The effects of concurrent medication, alcohol and compliance on stable control are well documented. Recent evidence also shows that supplemental vitamin K in patients with low body stores improves the stability of INR in these patients. Here, the case of a 57-year-old with coeliac disease requiring warfarin for a metallic mitral valve, who had poor INR stability resulting in thrombotic and bleeding complications, is described. Her vitamin K body stores were extremely low. Supplementation of vitamin K (100 µg daily) resulted in improvement in anticoagulation stability (mean (SD) 3.41 (1.68) vs 4.68 (3.34)). The percentage time spent within target INR range doubled following vitamin K supplementation. This case illustrates a relatively new approach to managing patients with highly unstable INR levels and provides extra understanding of factors influencing INR stability.
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