Phytonadione Utilization and the Risk of Bleeding in Chronic Liver Disease

• Published in: Hospital pharmacy (Philadelphia) 2024-12, Vol.59 (6), p.660-665
• Main Authors: He, Joanna, Cox, Tessa R., Gilbert, Brian W.
• Format: Article
• Language: English
• ISSN: 0018-5787; 1945-1253
• DOI: 10.1177/00185787241269114

Purpose: To determine the safety and efficacy of phytonadione in patients with an elevated international normalized ratio (INR) secondary to chronic liver disease without active bleeding. Methods: This retrospective chart review compared hospitalized patients from 2015 to 2022 with a diagnosis of chronic liver disease, a baseline INR of 1.2 to 1.9, and without active bleeding who did or did not receive phytonadione. The primary outcome was the incidence of new bleeding. The incidence of thrombosis and change in INR were also evaluated. Results: A total of 133 patients were included, of which 46 received phytonadione (mean 2.46 doses and mean dose 7.95 mg, 72.74% intravenously). Child-Pugh scores were higher in phytonadione patients (8.7 vs 9.93, P = .0003). There was no difference in the incidences of new bleeding (9.20 vs 13.04%, P = .492) or thrombosis (3.45 vs 0%, P = .203) between the control and phytonadione groups. After phytonadione administration, there was no change in INR, while INR increased by 0.24 in the control group (P = .025). Conclusion: In chronic liver disease patients who were not bleeding, phytonadione did not reduce INR or the incidence of new bleeding.