Possible Role of Vitamin K in Management of Gastrointestinal Bleeding

Abstract

Cirrhosis leads to an imbalance within the coagulation cascade this imbalance increases the risk of both bleeding and clotting in patients with cirrhosis 8, there are six proposed mechanisms may contribute to hemostatic imbalance like  decreased synthesis of procoagulant and anticoagulant proteins by the liver,impaired clearance of activated coagulation factors, platelet disorders, nutritional deficiency, fibrinolysis with dysfibrinogenemia, and disseminated intravascular coagulation (DIC). Vitamin K is a fat-soluble vitamin that allow the formation of coagulation factors and post-translational calcium binding to gamma-carboxylated proteins such as prothrombin, factors VII, IX, and X, protein C, and protein S, as well as those proteins found in bone and vascular smooth muscle  by acting  as a cofactor in the gamma-carboxylation of multiple glutamate residues. Vitamin K deficiency is common in certain types of liver disease, the decreased ability of the liver to complete the vitamin K cycle as a result of decreased function, despite evidence to the contrary, administration of vitamin K in a patient with cirrhosis to reverse an elevated INR has been a routine practice throughout the U.S. because patients with cirrhosis are categorically vitamin K-deficient also the administration of vitamin K is harmless  but this repletion is not supported by clinical outcomes, and most research shows that replacement is not an effective treatment for the coagulopathy of liver disease, especially in cirrhosis. has been found that Vitamin K is  significantly assosciated with decreasing in the PT and a PTT in cirrhotic Patients but does not affect any of the other measured parameters those decreases were not mirrored by other vitamin K-dependent proteins such as protein C, protein S, and factor VII, in contrast to the expected increase, protein C actually decreased after vitamin K administration and failure to show an increase in PIVKA-II levels at baseline in cirrhosis suggests that vitamin K deficiency does not play an integral role in the coagulopathy of these patients