Coagulopathy in cholestasis and malabsorption

Reduced synthesis of vitamin K-dependent clotting factors (II, VII, IX, X, proteins C, S) in conditions with impaired fat-soluble vitamin absorption. Develops in cholestatic liver disease, cystic fibrosis, short bowel syndrome, long-term parenteral nutrition, and coeliac disease. Laboratory: prolonged prothrombin time and INR; clinical: increased bleeding tendency.

ICD-10 E56.11 drug

Also known as: Vitamin K deficiency in malabsorption, Hypoprothrombinemia in cholestasis

Drugs used for this condition

APhytomenadioneFirst line · Vitamin K1, haemostatic, antidote for coumarin anticoagulant overdoseVitamin K1 is first-line for vitamin K-deficient coagulopathy in cholestatic liver disease, malabsorption syndromes (cystic fibrosis, coeliac disease, short bowel syndrome), and long-term parenteral nutrition. Doses: 5–10 mg IM or subcutaneously daily for 3 days, then guided by INR. In children with cholestasis: 1–2 mg/kg. In patients with severe coagulopathy and bleeding: 10 mg slow IV with concurrent PCC or FFP transfusion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit