{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T15:10:02Z","timestamp":1745593802707,"version":"3.40.4"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"published-print":{"date-parts":[[2009]]},"abstract":"<jats:p>Maintenance of a patient\u2019s international normalised ratio (INR) within the appropriate target range remains a challenge in clinical practice. The effects of concurrent medication, alcohol and compliance on stable control are well documented. Recent evidence also shows that supplemental vitamin K in patients with low body stores improves the stability of INR in these patients. Here, the case of a 57-year-old with coeliac disease requiring warfarin for a metallic mitral valve, who had poor INR stability resulting in thrombotic and bleeding complications, is described. Her vitamin K body stores were extremely low. Supplementation of vitamin K (100 \u03bcg daily) resulted in improvement in anticoagulation stability (mean (SD) 3.41 (1.68) vs 4.68 (3.34)). The percentage time spent within target INR range doubled following vitamin K supplementation. This case illustrates a relatively new approach to managing patients with highly unstable INR levels and provides extra understanding of factors influencing INR stability.<\/jats:p>","DOI":"10.1136\/bcr.10.2008.1067","type":"journal-article","created":{"date-parts":[[2009,5,18]],"date-time":"2009-05-18T06:32:47Z","timestamp":1242628367000},"page":"bcr1020081067","source":"Crossref","is-referenced-by-count":0,"title":["Supplemental vitamin K improves the stability of anticoagulation in a patient with low tissue stores of vitamin K secondary to coeliac disease"],"prefix":"10.1136","volume":"2009","author":[{"given":"Cassandra Emily","family":"Janeczko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Sweeney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Connaghan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2009,5,17]]},"reference":[{"key":"2025042507544669000_2009.may17_1.bcr1020081067.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68139-7"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.2","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1160\/TH04-12-0773","article-title":"Patients with unstable control have a poorer dietary intake of vitamin K compared with patients with stable control of anticoagulation","volume":"93","author":"Sconce","year":"2005","journal-title":"Thromb Haemost"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-09-049262"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.4","doi-asserted-by":"crossref","first-page":"6347","DOI":"10.1016\/S0021-9258(19)42259-X","article-title":"The mode of action of vitamin K. Identification of gamma-carboxyglutamic acid as a component of prothrombin","volume":"249","author":"Nelsestuen","year":"1974","journal-title":"J Biol Chem"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.5","first-page":"271","article-title":"A spectrum of partially carboxylated prothrombins in the plasma of coumarin treated patients","volume":"494","author":"Friedman","year":"1977","journal-title":"Biochem Biophys Acta"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.6","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.1_suppl.8S"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.7","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2001.02635.x"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.8","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1160\/TH04-06-0346","article-title":"Over the counter vitamin K1-containing multivitamin supplements disrupt anticoagulation in vitamin K1- depleted patients","volume":"92","author":"Kurnik","year":"2004","journal-title":"Thromb Haemost"},{"key":"2025042507544669000_2009.may17_1.bcr1020081067.9","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-007-0014-z"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.10.2008.1067","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T14:54:52Z","timestamp":1745592892000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.10.2008.1067"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009]]},"references-count":9,"alternative-id":["10.1136\/bcr.10.2008.1067"],"URL":"https:\/\/doi.org\/10.1136\/bcr.10.2008.1067","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2009]]}}}