Safety of Vitamin K in mechanical heart valve patients with supratherapeutic INR: A systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#blood-coagulation-disorders #heart-valves #humans #international-normalized-ratio #thromboembolism

Safety of Vitamin K in mechanical heart valve patients with supratherapeutic INR: A systematic review and meta-analysis

Sapapsap et al., 2022 | Medicine (Baltimore) | Meta Analysis

Citation

Sapapsap Bannawich, Srisawat Chansinee, ... Kanchanasurakit Sukrit. Safety of Vitamin K in mechanical heart valve patients with supratherapeutic INR: A systematic review and meta-analysis. Medicine (Baltimore). 2022-Sep-09;101(36):e30388. doi:10.1097/MD.0000000000030388

Abstract

BACKGROUND: Patients who had mechanical heart valves and an international normalized ratio (INR) of >5.0 should be managed by temporary cessation of vitamin K antagonist. This study aimed to investigate the safety of low-dose vitamin K1 in patients with mechanical heart valves who have supratherapeutic INR. METHODS: CINAHL, Cochran Library, Clinical trial.gov, OpenGrey, PubMed, ScienceDirect, and Scopus were systematically searched from the inception up to October 2021 without language restriction. Studies comparing the safety of low-dose vitamin K1 treatment in patients with placebo or other anticoagulant reversal agents were included. We used a random-effect model for the meta-analysis. Publication bias was determined by a funnel plot with subsequent Begg's test and Egger's test. RESULTS: From 7529 retrieved studies, 3 randomized control trials were included in the meta-analysis. Pooled data demonstrated that low-dose vitamin K was not associated with thromboembolism rate (risk ratio [RR] = 0.94; 95% CI: 0.19-4.55) major bleeding rate (RR = 0.58; 95% CI: 0.07-4.82), and minor bleeding rate (RR = 0.60; 95% CI: 0.07-5.09). Subgroup and sensitivity analysis demonstrated the nonsignificant effect of low-dose vitamin K on the risk of thromboembolism. Publication bias was not apparent, according to Begg's test and Egger's test (P = .090 and 0.134, respectively). CONCLUSION: The current evidence does not support the role of low-dose vitamin K as a trigger of thromboembolism in supratherapeutic INR patients with mechanical heart valves. Nevertheless, more well-designed studies with larger sample sizes are required to justify this research question.

Key Findings

From 7529 retrieved studies, 3 randomized control trials were included in the meta-analysis. Pooled data demonstrated that low-dose vitamin K was not associated with thromboembolism rate (risk ratio [RR] = 0.94; 95% CI: 0.19-4.55) major bleeding rate (RR = 0.58; 95% CI: 0.07-4.82), and minor bleeding rate (RR = 0.60; 95% CI: 0.07-5.09). Subgroup and sensitivity analysis demonstrated the nonsignificant effect of low-dose vitamin K on the risk of thromboembolism. Publication bias was not apparent,

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population mechanical heart valves who
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Blood Coagulation Disorders
  • Heart Valves
  • Humans
  • International Normalized Ratio
  • Thromboembolism
  • Vitamin K
  • Vitamin K 1
  • Vitamins

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09