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Prophylactic vitamin K for vitamin K deficiency bleeding in neonates

Vitamin K injection can prevent hemorrhagic disease of the newborn. Vitamin K helps the blood to clot but the body's capacity to store it is very low. Hemorrhagic disease of the newborn (HDN) is caused by a deficiency of Vitamin K in newborns and results in life‐threatening bleeding in an infant in the first hours to months of life. Classic HDN occurs on days one to seven and late HDN occurs from week two to 12. Some Vitamin K comes from the placenta but it is not always enough. The review of randomized trials found that a single injection of Vitamin K prevents classic HDN.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin

People who have a stroke due to a blockage of an artery have a higher risk of having another possibly fatal stroke, or a heart attack. Treatment with antiplatelet drugs (like aspirin) definitely reduces this risk. Blood thinning treatment (anticoagulation by vitamin K antagonists) was believed to provide added protection. We reviewed eight trials involving 5762 participants that compared anticoagulants with antiplatelet agents for preventing recurrent stroke and found no benefit of low intensity anticoagulation over aspirin, and an increased risk of bleeding with high intensity anticoagulation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Vitamin K for upper gastrointestinal bleeding in people with acute or chronic liver diseases

We reviewed vitamin K for upper gastrointestinal bleeding in people with acute liver disease (that is, loss of normal liver functions which occurs in days or weeks; most often, people do not have a pre‐existing liver disease) or chronic liver disease (that is, progressive destruction of normal liver functions, usually associated with fibrotic regeneration of the liver tissue).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Length of treatment with vitamin K antagonists and prevention of recurrence in patients with venous thromboembolism

Venous thromboembolism (VTE) occurs when a blood clot is formed in a deep vein, or when it detaches itself and lodges in the lung vessels. These clots can be fatal if blood flow to the heart is blocked. Vitamin K antagonists (VKA) are given to people who have experienced a VTE, to prevent recurrence. The major complication of this treatment is bleeding. The continuing risk of bleeding with drug use and uncertainty regarding the extent of the risk of recurrence make it important to look at the proper duration of treatment with VKA for these patients. The review authors searched the literature and were able to combine data from 11 randomized controlled clinical trials (3716 participants) comparing different durations of treatment with VKA in patients with a symptomatic VTE. Participants receiving prolonged treatment had around five times lower risk of recurrence of VTE. On the other hand, they had about three times higher risk of bleeding complications. Prolonged treatment did not reduce the risk of death. Prolonged use of VKA strongly reduced the risk of recurrent clots as long as they were used, but benefit decreased over time and the risk of major bleeding remained.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Vitamin K prior to preterm birth for preventing neonatal periventricular haemorrhage

Vitamin K given to women before a very preterm birth does not decrease the risk of bleeding in the brain and associated neurological injury in babies born very preterm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Vitamin K supplementation for cystic fibrosis

We reviewed the evidence to see whether supplementing vitamin K in people with cystic fibrosis counteracts the effects of deficiency on blood clotting, bone strength and quality of life in people with cystic fibrosis. We tried to determine the best dose needed to prevent this deficiency.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The addition of vitamin K to improve anticoagulation stability for patients starting or already on warfarin

People with irregularity in heart activity, mechanical heart valves, and clotting disorders are at increased risk of developing blood clots, which could lead to stroke or death. Taking warfarin significantly reduces this risk. However, taking too much warfarin can lead to excessive bleeding, while taking too little reduces its benefit. To monitor this, patients taking warfarin must have regular blood tests to check if their dose of warfarin is stable enough to find the correct balance. There is some evidence that adding a small dose of vitamin K to the warfarin improves this balance. In this review, our primary outcomes were to assess if the addition of low‐dose vitamin K to warfarin had an effect on the time taken to the first INR in range; the mean within the therapeutic range; or any adverse events, such as thromboembolic events, haemorrhage, or mortality. We found two studies that met our inclusion criteria. Neither study reported the time taken to the first INR in range. One study was only available in an abbreviated format, so we were unable to interpret the results fully. Nonetheless, it was suggested that the addition of vitamin K had no benefit. A second six‐month study gave a small dose of vitamin K (150 mcg daily) or placebo to participants taking warfarin with existing poor INR control. This study reported the mean time in therapeutic range as a percentage and found that in the group of participants deemed to have poor INR control, the addition of 150 mcg oral vitamin K significantly improved their anticoagulation control. However, the study was relatively small. Neither study reported any adverse events, such as thromboembolism, haemorrhage, or death. We conclude that further larger, higher quality studies are needed to conclude whether adding vitamin K to warfarin for patients starting or already on warfarin improves their anticoagulation control.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Vitamin K supplementation to prevent cardiovascular disease

Cardiovascular disease (CVD) refers to a group of conditions affecting the heart and blood vessels. CVD is a global burden and varies between regions, and this variation has been linked in part to dietary factors. Such factors are important because they can be modified to help with CVD prevention and management.This review assessed the effectiveness of vitamin K supplementation as a single supplement at reducing cardiovascular death, all‐cause death, non‐fatal endpoints (such as heart attacks, strokes and angina) and CVD risk factors in healthy adults and adults at high risk of CVD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Vitamin K antagonists or low‐molecular‐weight heparin for long term treatment of symptomatic blood clots

Blood clots (venous thromboembolism) sometimes cause blockages in veins after surgery, during bed rest, or spontaneously. These clots can be fatal when they travel to the lungs. Vitamin K antagonists (VKAs), 99% of which consist of warfarin, are effective in preventing renewed blood clot formation, because they thin the blood. Low‐molecular‐weight heparins (LMWHs) are drugs that thin the blood and are used for people who are at risk of major bleeding, people who cannot take vitamin K antagonists, and pregnant women.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non‐bleeding patients

Prothrombin complex concentrate (PCC) is a drug that contains a source of proteins involved in the human blood clotting process. Patients medicated with vitamin K antagonists (blood thinning drug) have low blood levels of these important blood clotting proteins. Therefore these patients will be at increased risk of spontaneous and traumatic bleeding events. Also, when these patients experience a bleeding event, this will lead to progressive loss of these important blood clotting proteins. This process causes a vicious circle, thereby increasing risks of illness and death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Direct thrombin inhibitors compared with vitamin K antagonists in people with atrial fibrillation for preventing stroke

Question: We wanted to compare the effectiveness and safety of direct thrombin inhibitors (DTIs) with vitamin K antagonists in people with atrial fibrillation (AF) to prevent stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Neonatal Vitamin K Administration for the Prevention of Hemorrhagic Disease: A Review of the Clinical Effectiveness, Comparative Effectiveness, and Guideline [Internet]

The aim of this report is to review the clinical effectiveness of intramuscular vitamin K, the comparative effectiveness between oral and intramuscular vitamin K, and guidelines regarding the administration of oral vitamin K for the prevention of vitamin K deficiency bleeding (VKDB).

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 28, 2015
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The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice: systematic review and economic evaluation

The study found that, for people receiving long-term vitamin K antagonist therapy, self-monitoring is safe and clinically effective, compared with standard monitoring. Self-monitoring appears to be also cost-effective because it reduces the incidence of thromboembolic events. Trials are needed to investigate long-term outcomes of self-monitoring.

Health Technology Assessment - NIHR Journals Library.

Version: June 2015
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Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet]

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein and then dislodges to travel in the blood (an embolus). A venous thrombus most commonly occurs in the deep veins of the legs or pelvis; this is then called a deep vein thrombosis (DVT). Blood flow through the affected vein can be limited by the clot, and it can cause swelling and pain in the leg. If it dislodges and travels to the lungs, to the pulmonary arteries, it is called a pulmonary embolism (PE), which in some cases may be fatal. VTE as a term includes both DVT and PE. Major risk factors for VTE include a prior history of DVT, age over 60 years, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility, thrombophilia (an abnormal tendency for the blood to clot) and pregnancy.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012
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Vitamin K to prevent fractures in older women: systematic review and economic evaluation

The focus of this report is to establish whether vitamin K can be used cost-effectively in the treatment of women who are osteoporotic and who have a previous fracture.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2009

Bleeding risk in atrial fibrillation patients taking vitamin K antagonists: systematic review and meta-analysis

Vitamin K antagonists (VKAs) prevent stroke in atrial fibrillation (AF) at the cost of bleeding risk. To determine major bleeding rates in AF patients, we conducted a systematic review that identified 51 eligible studies including more than 342,699 patients. The pooled estimate of the rate of major bleeding was 2.51 (99% confidence interval: 2.03-3.11) bleeds per 100 patient-years. The results represent the best estimates of bleeding risk that most patients contemplating VKA use may expect.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The role of oral vitamin K antagonists in the outcome of infrainguinal bypass procedures

We investigated the role of oral vitamin K antagonists (VKAs) in graft patency, limb salvage, major and minor bleeding rates in patients undergoing infrainguinal bypass surgery. Five randomized-controlled trials (RCTs; n = 3746 patients) comparing VKA versus non-VKA treatment outcomes in patients undergoing infrainguinal bypass surgery were analyzed. The VKA treatment was associated with improved graft patency rates when a vein graft was used (risk ratio [RR]: 0.74; P = .0004), while there was no difference with prosthetic grafts (RR: 1.07; P = .39). The VKA treatment was also associated with improved limb salvage rates (RR: 0.33; P = .0008). Major and minor bleeding complications were higher in the VKA group. In conclusion, VKA treatment is associated with improved graft patency and limb salvage rates when a vein graft is used at the price of an increased risk of bleeding. Due to the inconsistent results, further well-designed RCTs are needed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

New oral anticoagulants for the treatment of acute venous thromboembolism: are they safer than vitamin K antagonists? A meta-analysis of the interventional trials

New oral anticoagulants (NOACs) may represent an alternative to standard therapy with vitamin K antagonists (VKA). However, up to the present, it is unknown whether these drugs are safer than VKA. The aim of this study was to perform a meta-analysis of the interventional trials with NOACs vs VKA in patients with acute venous thromboembolism (VTE) to obtain the balance between clinical efficacy and complications. A meta-analysis of double blind randomized controlled trials (RCTs) was performed. We included RCTs that compared, in acute VTE, the beneficial and harmful effects of NOACs (ximelagatran, apixaban, dabigatran, edoxaban and rivaroxaban) vs VKA (warfarin). Seven studies including 29,482 patients were selected. Compared with warfarin, recurrent VTE and death from any cause were not significantly reduced by NOACs. Myocardial infarction was significantly increased with NOACs compared with warfarin (RR 2.55; 95 % CI 1.1-5.6; p = 0.02). NOACs significantly reduced the major bleedings (RR 0.63; 95 % CI 0.47-0.83; p = 0.001). This meta-analysis suggests that treatment with NOACs in patients with acute VTE is not inferior to conventional therapy with warfarin for recurrent VTE and death from any cause, but there might be an increased incidence of myocardial infarction.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Antithrombotic drugs to prevent further blood vessel blockage after bypass surgery using vein grafts obtained from the same person (autologous) or artificial grafts in the legs

Lower limb atherosclerosis can lead to blocked blood vessels causing pain on walking (intermittent claudication) or, if more severe, pain at rest, ulceration and gangrene (critical limb ischaemia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Blood thinners for the long‐term treatment of blood clots in patients with cancer

Patients with cancer are at an increased risk of developing blood clots and might respond differently to blood thinners (anticoagulants) compared with patients without cancer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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