Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Chronic liver disease is a growing cause of morbidity and mortality in the United States. Recognizing appropriate pharmacologic interventions is an important skill for pharmacists who seek to care for these patients.

One complication from chronic liver disease, especially in patients with cirrhosis, is abnormal coagulation. These patients have been observed to have higher rates of both bleeding and thrombotic events and often present with an elevated baseline INR. While Vitamin K administration is often used in patients on vitamin K antagonist therapy in order to reduce the risk of bleeding, it is unclear what the clinical benefit of such therapy provides in chronic liver disease patients. Further, the risk of vitamin K administration in this patient population and if such intervention could increase risk for thrombosis has not been established.

For the purposes of this presentation, literature surrounding the use of vitamin K administration in patients with chronic liver disease for INR reversal will be explored, with additional focus on the pathophysiology of coagulation abnormalities in cirrhosis and their relation to hepatic insufficiency and vitamin K deficiency.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Recognize key factors leading to coagulation abnormalities in chronic liver disease
• Describe the evidence surrounding the benefits and risks of vitamin K administration for INR reversal in chronic liver disease
• Discuss whether vitamin K administration is indicated for a specific patient case
  

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. The assigned universal program number(s) is JA4008223-0000-23-112-H01-P. This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit. Disclaimer Statement:  The information presented at this activity represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

Suggested Additional Reading & Joint Accreditation Statement - Note: This Accreditation Statement Supersedes All Other Statements:

Suggested Additional Reading:

1. Aldrich, SM, & Regal, RE (2019, March). Routine use of Vitamin K in the treatment of cirrhosis-related coagulopathy: Is it A-O-K? maybe not, we say. P & T : a peer-reviewed journal for formulary management. Retrieved February 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385738/
2. Barmore, W. (2021, May 9). Biochemistry, clotting factors. StatPearls. Retrieved March 10, 2022, from https://www.statpearls.com/articlelibrary/viewarticle/19638/
3. Dabbagh, O, Oza, A, Prakash, S, et al. (2010). Coagulopathy does not protect against venous thromboembolism in hospitalized patients with chronic liver disease. Chest, 137(5), 1145–1149. https://doi.org/10.1378/chest.09-2177
4. Farkas, J. (2021, November 29). Coagulopathy in Cirrhosis. EMCrit Project. Retrieved March 10, 2022, from https://emcrit.org/ibcc/cirrhosis/
5. Gilmore, I. T., Burroughs, A., Murray-Lyon, I. M., Williams, R., Jenkins, D., & Hopkins, A. (1995). Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: An audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut, 36(3), 437–441. https://doi.org/10.1136/gut.36.3.437
6. Harrison, M. (1996). The misunderstood coagulopathy of liver disease: A review for the acute setting. Western Journal of Emergency Medicine, 19(5), 863–871. https://doi.org/10.5811/westjem.2018.7.37893
7. Heron, M. (2021). Deaths: Leading Causes for 2019. National Vital Statistics Report, 70(9). https://doi.org/10.15620/cdc:107021

Joint Accreditation Statement - this statement supersedes any other statement on this page In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Pharmacy (CPE) - This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit.

Other Healthcare Professionals: Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.