Administration, Oral ; Humans ; Infant, Newborn ; Vitamin K

BACKGROUND: Two types of local reactions due to cutaneous administration of vitamin K. eczematoid, and indurated pilaque and localized scleroderma, have been described. In the acute phase, a generalized maculopapular eruption (Id reation) may accompany either reaction. Liver disease has been reported with vitamir K hypersensitivity but the mechanism of vitamin K dermatitis is unknown. OBJECTIVE & MEHTODS: In 10 of vitamin K dermatitis patients, we studied the clinical features, histopathologic findings, and provocation tests (patch test & intrader nal test). RESULTS: 1. All patients had localized erythematous plaque but none had sclerodermoid skin eruption. Four patients were associated with Id reaction. 2. The onsets of eruptions after initial injection of vitamin K were within one week (one case), 2 to 3weeks(seven cases), or 3 weeks (two cases), and the doses of administered vitamin K were between 30 and 310 mg. 3. Four had liver diseases and 5 had blood eosinophilia. 4. Of 7 patients who had patch-and intradermal test, intradermal test showed all positive at either day 2 or day 4 but patch test were all negative. 5. The histopathologic findings of all the cases showed perivascuiiar and diffuse infiltrations of numeroas osinophils and mononuclear cells and one case showed panniulitis. CONCLUSION: The cell-mediated immune reaction may play a role on the pathogenesis of vitamin K, dermatitis. Liver dysfuncticn and/or another factors may be a precivitating factor of vitamin K dermatitis, and intradermal the seems to be more useful in the diagnoiis of vitamin K dermatitis than patch test.
Administration, Cutaneous ; Dermatitis* ; Eosinophilia ; Humans ; Hypersensitivity ; Intradermal Tests ; Liver ; Liver Diseases ; Patch Tests ; Scleroderma, Localized ; Skin ; Vitamin K ; Vitamin K 1* ; Vitamins*

Warfarin resistance is a phenomenon that patients need to take much higher than normally prescribed dosage of warfarin to maintain the target therapeutic international normalized ratio (INR) range, or even fail to reach the target INR. Warfarin resistance can be categorized in etiologic terms as hereditary vs acquired, or in pharmacologic terms as pharmacokinetic vs pharmacodynamic. Once warfarin resistance is diagnosed, the type of resistance should be determined as soon as possible so that treatment could be oriented toward the causes. Poor compliance, genetic mutations, concurrent medications that could decrease the absorption or increase the clearance of warfarin, and consumption of diet rich in vitamin K are the major reasons for warfarin resistance. Educating patients, increasing warfarin dosage and switching to other anticoagulants would be effective for warfarin resistance.
Anticoagulants ; pharmacology ; Drug Monitoring ; methods ; Female ; Humans ; International Normalized Ratio ; Male ; Metabolism, Inborn Errors ; diagnosis ; etiology ; genetics ; Vitamin K ; administration & dosage ; Vitamin K Epoxide Reductases ; genetics

There are inconsistent findings on the effects of vitamin K on bone mineral density (BMD) and undercarboxylated osteocalcin (UcOC). The present intervention study evaluated the effect in subjects over 60-yr-old. The vitamin K group (vitamin K + vitamin D + calcium supplement; 15 mg of vitamin K2 [menatetrenone] three times daily, 400 IU of vitamin D once a day, and 315 mg of calcium twice daily) and the control group (vitamin D + calcium supplement) were randomly assigned. During the six months of treatment, seventy eight women participated (38 in the vitamin K group and 40 in the control group) and 45 women completed the study. The baseline characteristics of study participants did not differ between the vitamin K and the control groups. In a per protocol analysis after 6 months, L3 bone mineral density has increased statistically significantly in the vitamin K group compared to the control group (0.01 +/- 0.03 g/cm2 vs -0.008 +/- 0.04 g/cm2, P = 0.049). UcOC concentration was also significantly decreased in the vitamin K group (-1.6 +/- 1.6 ng/dL vs -0.4 +/- 1.1 ng/dL, P = 0.008). In conclusion, addition of vitamin K to vitamin D and calcium supplements in the postmenopausal Korean women increase the L3 BMD and reduce the UcOC concentration.
Aged ; Bone Density/*drug effects ; Calcium/*administration & dosage ; Dietary Supplements ; Female ; Humans ; Middle Aged ; Osteocalcin/*blood ; Postmenopause ; Republic of Korea ; Vitamin D/*administration & dosage ; Vitamin K/*administration & dosage

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*

Congenital combined deficiency of vitamin K dependent coagulation factors is a rare coagulation disorder. We experienced a 20-month old boy who was found to have a congenital vitamin K dependent coagulation factor defeciency. He presented with continuous bleeding on lacerated hard palate and had a history of numerous hemorrhagic episodes with multiple bruises after birth. Laboratory finding showed prolonged prothrombin time and partial thromboplastin time. Blood coagulation work-up showed marked decreased activities of the coagulation factors II, VII, IX, X and the natural anticoagulants proteins C and S. Assay of coagulation factors in the parents and sibling were with the normal range. There's no evidence of malabsorption, liver disease or ingestion of a coumarin compound. Response to intravenous administration of vitamin K1 was not significant but transfusion of fresh frozen plasma corrected prothrombin time and partial thromboplastin time. We reported a case of congenital combined deficiency of vitamin K dependent coagulation factors.
Administration, Intravenous ; Anticoagulants ; Blood Coagulation ; Blood Coagulation Factors ; Contusions ; Eating ; Hemorrhage ; Humans ; Infant ; Liver Diseases ; Male ; Palate, Hard ; Parents ; Partial Thromboplastin Time ; Parturition ; Plasma ; Prothrombin Time ; Reference Values ; Siblings ; Vitamin K 1 ; Vitamin K* ; Vitamins*

OBJECTIVETo investigate the possible relationship between vitamin K epoxide reductase complex 1 (VKORC1) gene polymorphism and warfarin dose requirements in Chinese patients.

METHODGenotyping for the C1173T polymorphism in the VKORC1 gene was performed using a restriction enzyme digestion of PCR-amplified DNA in 102 Chinese patients treated with warfarin.

RESULTSTT genotype was found in 83 patients (81.4%), CT genotype in 16 patients (15.7%) and CC genotype in 3 patients (2.9%). To achieve similar target INR range (1.5 - 2.5), the warfarin dose requirement was significantly lower in patients with TT genotype than that in patients with CT/CC genotypes (P < 0.01).

CONCLUSIONC1173T polymorphism in the VKORC1 gene might be one important determinant for warfarin dose requirement in Chinese patients.

Adult ; Aged ; Asian Continental Ancestry Group ; genetics ; Dose-Response Relationship, Drug ; Female ; Genotype ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Mixed Function Oxygenases ; genetics ; Polymorphism, Single Nucleotide ; Vitamin K 1 ; Vitamin K Epoxide Reductases ; Warfarin ; administration & dosage

OBJECTIVETo summarize the clinical characteristics of secondary coagulation disorders caused by exposure to poison (raticide) in children and to investigate the diagnosis and corresponding treatment.

METHODThe process of diagnosis, clinical characteristics, response to treatment and the prognosis were analyzed.

RESULTSThe main clinical manifestation was mucosal bleeding (66.6%), including epistaxis, gingival bleeding, hematomas and so on. All these children were previously well and had no history of bleeding. Activated partial thromboplastin time (APTT) and prothrombin time (PT) were prolonged, factor II was undetectable and the levels of factors VII, IX, and X were lower. The fibrinogen was normal. A raticide was detected in blood and urine of 13 children although 12 of the patients had no definite history of raticide ingestion. Prothrombin complex, fresh frozen plasma and vitamin K(1) were effective in these cases. However, 2 - 3 weeks later, 6 patients presented with recurrent bleeding.

CONCLUSIONFor children with secondary coagulation disorders of unknown cause, intoxication of raticide should be considered. The administration of blood coagulation factors and vitamin K(1) are effective in early treatment, and the treatment period should be more than 2 months. The PT and APTT should be followed up. Vitamin K(1) should be stopped when PT and APTT are normal.

Blood Coagulation Disorders ; chemically induced ; diagnosis ; therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Rodenticides ; poisoning ; Vitamin K 1 ; administration & dosage ; therapeutic use

Vitamin K is a naturally-occurring vitamin used to treat certain coagulation disorders. Despite its frequent use, vitamin K causes allergic reactions very rarely. We report a case of anaphylaxis due to vitamin K (phytonadione) that occurred in a 20-year-old man who has undergone hemorrhoid bleeding. The patient developed immediate whole body urticaria, itching sensation, dyspnea and marked hypotension about 2 minutes after the intravenous administration of vitamin K (phytonadione) and tranexamic acid for the purpose of bleeding control. Skin prick test was performed with vitamin K and tranexamic acid. Vitamin K showed positive response in skin prick test, while tranexamic acid showed negative response in skin prick test and challenge test. To our knowledge, it is the first case report of vitamin K-induced anaphylaxis that is proven with skin test. This case suggests that vitamin K can elicit anaphylaxis and skin test may be helpful in the diagnosis of a suspected allergic response to vitamin K.
Administration, Intravenous ; Anaphylaxis* ; Diagnosis ; Drug Hypersensitivity ; Dyspnea ; Hemorrhage ; Hemorrhoids ; Humans ; Hypersensitivity ; Hypotension ; Pruritus ; Sensation ; Skin ; Skin Tests ; Tranexamic Acid ; Urticaria ; Vitamin K ; Vitamins* ; Young Adult

Object We aimed to compare the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonist (VKA) in the prevention and treatment of thrombotic diseases in patients with active cancer. Methods: To find randomized controlled trials (RCT) in which NOACs were compared VKAs in active cancer, we searched the electronic databases (PubMed, Web of Science and Clinical Trials) up to May 2019 and and languages restricted to Chinese and English. According to the screening strategy, two researchers independently screened and extracted literature, evaluated the quality of literature, the suitability of collected cross study data for analysis, and tested the heterogeneity. The relative risk (RR) and 95% confidence interval (95%CI) of major bleeding, clinically related non-major bleeding, VTE, stroke and all-cause mortality in active cancer patients with VTE, active cancer patients with non-valvular atrial fibrillation (NVAF) was calculated and the results were compared between NOAC with VKA. Results: A total of 9 RCTs were included, including 5 cancers with VTE (5/9) and 4 cancers with NVAF (4/9). A total of 5 867 patients were included. After excluding 1 818 (30.99%) patients with cancer history, 4 049 (68.86%) patients with active cancer were statistically analyzed. Among them, 2 278 (56.26%) received NOAC treatment, 1 771 patients (43.74%) received VKA treatment. The quality of the included documents was high (all scores were>5 points), and the data of each included document could be summarized and analyzed (P>0.05). The heterogeneity of main outcome events was very low (I² = 0). In VTE patients with active cancer, NOACs were more effective in reducing recurrence of VTE （RR=0.55, 95%CI 0.36 -0.84; P = 0.005) and clinically related non-major bleeding (RR=0.77, 95%CI 0.60 -0.98; P = 0.03) than VKAs. In NVAF patients with active cancer, efficacy of NOACs and VKAs was similar in terms of reducing VTE, stroke, clinically related non-major bleeding, major bleeding and all-cause mortality events (P>0.05). Conclusions: For patients with active cancer accompanied by VTE, NOAC may has more advantages in efficacy and safety compared to VKA in the prevention and treatment of thrombotic diseases.
Administration, Oral ; Anticoagulants/therapeutic use* ; Atrial Fibrillation/drug therapy* ; Humans ; Neoplasms/drug therapy* ; Randomized Controlled Trials as Topic ; Venous Thromboembolism/prevention & control* ; Vitamin K/therapeutic use*