Introduction the criteria; therefore, no relevant studies can be


As believed, the daily
supplementation with low-dose of vitamin K might improve anticoagulation
control, which caused difficulties in managing warfarin therapy. This study was
reviewing the previous medical studies, in order to conduct whether reducing
vitamin K supplementation can deduce the detrimental in clinically used of VKA.

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Moreover, it also conducts the effect of daily low-dose vitamin K supplement on
major bleeds, thromboembolic events and in stabilizing International normalized
ratio (INR) in the patients who were taking VKAs. As a result of drug and food
interaction, monitoring the anticoagulant effect of VKAs by using INR are
needed that INR is a response to warfarin therapy which influenced by intake of
vitamin K.



This study used the patients who are older than 18 years and on VKA
therapy. All controlled trials studies are randomized and published between
1970 and August 2012. The criteria of this study were included the studies that
compared pharmaceutically prepared vitamin K supplement to placebo. The outcomes
interested in the rate of haemorrhagic and thromboembolic events as well as
estimate the time in therapeutic range (TTR). Two independent reviewers only reviewed
English language full-text articles that were included VKA therapy and involves
the daily use of vitamin K. The used in the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) system is to access the quality
of evidence.



Only three of the articles were included in the study. The other
excluded articles do not meet the criteria; therefore, no relevant studies can
be identified from the reference lists of review articles. The results in all
three articles reported TTR as an outcome, which is higher in the patients who were
receiving vitamin K supplements. As well as the INR control were 3.5 % more
than patients who were receiving placebo. The report from the trials, the
bleeding is not verifying and no clear definition of thromboembolic events.



The systematic reviews show Vitamin K supplements are not useful in
improving the stability of INR control in patients receiving VKAs. The study
has limitation caused by a small number of included trials and the group of
patients with poor INR control are lacked studied. The reviewers may also have
missed the relevant studies which are written in the language other than
English. The quality of evidence was rated as low due to the risk of bias and
imprecision. These results insufficiently suggested that the daily low-dose
vitamin K supplements are useful in strengthening the outcome of stabilizing
INR control.



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