Rebleeding in variceal and nonvariceal gastrointestinal bleeds in cirrhotic patients using vitamin K1: The LIVER-K study

Abstract

Background: Gastroesophageal varices are the most common cause of upper gastrointestinal bleeding (UGIB) in patients with cirrhosis. Vitamin K1is commonly administered to patients presenting with UGIB and elevated international normalized ratio, despite limited evidence to support this practice. Objectives: The primary objective was to describe the incidence of rebleeding within 30 days after vitamin K1administration in patients with cirrhosis and UGIB. The secondary objective was to describe prescribing patterns for vitamin K1. Methods: This retrospective, descriptive multicentre study involved patients with cirrhosis and UGIB who were admitted to any of the 4 adult acute care hospitals in Calgary, Alberta, from January 1, 2014, to December 31, 2016. Patients were divided into 2 groups: those who received vitamin K1and those who did not. Results: A total of 370 patients met the inclusion criteria, of whom 243 received vitamin K1and 127 did not. Baseline characteristics were similar between the groups. Greater proportions of patients in the vitamin K1group received transfusions of packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate, or prothrombin concentrate during their admissions. There was no significant difference in the duration of octreotide and pantoprazole infusions. Among patients in the vitamin K1group, there were more admissions to the intensive care unit and longer lengths of stay. More patients in the no vitamin K1group had esophageal varices evident on endoscopy that required endoscopic treatment. Forty of the patients (16.5%) in the vitamin K1group and 7 (5.5%) in the no vitamin K1group had rebleeding within 30 days of the initial bleed. The median total vitamin K1dose administered was 25 mg. Conclusions: The study results suggest that vitamin K1does not reduce the incidence of rebleeding within 30 days of the initial bleed in patients with cirrhosis and UGIB.