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Vit K for baby w/maternal blood clotting disorders? - Page 3

post #41 of 54
ST, I love you. Thanks for so beautifully posting your point. I'm sorry you ever had to experience this, and I pray everyday for your beautiful baby 'Paris'
post #42 of 54
"In the blood coagulation cascade, prothrombin is cleaved by factor Xa to form thrombin, an active serine protease (Narayanan, 1999). This proteolytic reaction occurs on the phospholipid surfaces of platelets and requires calcium. Thrombin is responsible for inducing platelet aggregation and activating several other mediators in the coagulation cascade. It converts fibrinogen to fibrin, which then polymerizes to form a clot around platelet aggregates. Thrombin also converts factor XIII to factor XIIIa, an enzyme that cross-links and stabilizes fibrin polymers. The prothrombotic effects of thrombin are ultimately suppressed by the binding of thrombin to thrombomodulin on endothelial cell surfaces to form a complex that activates protein C. Protein C then degrades factors Va and VIIIa to inhibit the coagulation cascade."

aspirin reduces platelet aggregation so directly or indirectly it has to do with vitamin K related clotting factors (prothombin is factor II) so I do not understand how increasing vitamin k would not result in a change in the effectiveness of treatment. I am not trying to be difficult here I will have to find a friendly hemotologist to talk to sort this out more- on to do some more research--
post #43 of 54
Quote:
Originally Posted by mwherbs
aspirin reduces platelet aggregation so directly or indirectly it has to do with vitamin K related clotting factors (prothombin is factor II) so I do not understand how increasing vitamin k would not result in a change in the effectiveness of treatment. I am not trying to be difficult here I will have to find a friendly hemotologist to talk to sort this out more- on to do some more research--
I'm having a hard time thinking of how to explain without resorting to biochemical pathway talk. Vitamin K acts 'upstream' of platelets. Aspirin acts on platelets, but that action is downstream of vitamin K. If you act directly on something downstream, upstream interventions may or may not be able to interfere with the end result.

In this case, if you give aspirin, the platelets are inherently less sticky. Adding more vitamin K to the system, even if that results in higher concentration of vit K dependent clotting factors, shouldn't make the platelets more sticky. The platelet stickiness is independent of the clotting factors. That stickiness is a property of the platelet itself.

The difference between aspirin, heparin, and the oral anticoagulants is that the oral drugs directly impact vitamin K activity. Adding extra vitamin K to the system would interfere with that type of treatment.

Someone on aspirin or heparin is unlikely to be deficient in vitamin K, unless they're also on oral anticoagulants. So far (and this is the key question!) I haven't found any evidence that adding extra vitamin K will make a person with non-limiting (normal) levels of vitamin K clot faster. (It is however, true that someone seriously deficient in vit K will clot better if vit K is administered.)

As an aside, very high doses of aspirin do directly interfere with the vit K dependent clotting pathway, although I'm not sure exactly which step is affected. I'm pretty sure it is moot though, because as a rule, high dosages of aspirin aren't given for clot prophylaxis.
post #44 of 54
Quote:
It is however, true that someone seriously deficient in vit K will clot better if vit K is administered.
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.

WRT to aspirin, warfarin and Low Molecular Weight Heparins (LMWHs), Warfarin acts on the liver and the production of Vit K so is affected by diet as J says. All warfarin patients are advised to either maintain a steady intake of Vit K or keep it to a minimum. This is to facilitate regulation of the necessary dosage of warfarin, which is notorioulsy difficult at the best of times without having broccoli soup every day one week and not the next!

This article explains it well.

A short list of Vit K in food is here

If you are taking warfarin and any vitamin supplements look for one without Vit K - pregnancy multivitamins often don't have it.

LMWH works differently by binding to antithrombin III and inhibiting clotting that way.
post #45 of 54
Quote:
Originally Posted by orangefoot
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.
Nature provides for babies to be born deficient in vitamin K because Nature never intended for them to be poked, pulled, prodded, pinched, pricked, and processed the way the hospital routines treat newborns.

Newborns are treated gingerly and carefully by their mothers instinctively in more natural settings.

Vitamin K is made in the gut and processed by the liver when their digestive system gets going. The clotting factor is in gear, usually, by the end of the first week.
post #46 of 54
Quote:
Originally Posted by orangefoot
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.
But if all babies are deficient in vitamin K, then the fact is that none of them are deficient, right? They're just normal.

However, there is a subset of newborns who are truly vitamin K deficient. For whatever reasons, these newborns have used up their limited supply of vitamin K, and don't have enough left to continue producing clotting factors at a reasonable rate. The vitamin K they had will regenerate itself, but that takes some time. So in the meantime, supplemental vitamin K may prevent serious bleeds.

Since one can't tell by looking which babies are truly low in vitamin K (compared to other newborns), it is routinely given to all. But that is very different from saying that newborns are deficient in vitamin K.
post #47 of 54
I like the idea of a forum to discuss clotting disorders.
post #48 of 54
I said that was the reasoning, I didn't say I agreed with it! I should have said the medical reasoning.

A lack (compared to adult levels) is always perceived as a problem, which it can be, but in these circumstances it is not necessarily so.

Children have low PSD naturally as do pregnant women (hence false positive PSD diasgnosis during pregnancy) This must be because during pregnancy we need protection from bleeding, as do small children; how many bumps and scrapes do they have when they are little?

However, current OB practice does involve a lot of messing around and possible trauma so it is entirely possible that more cases of HDN have been reported and instead of reducing interventions, Vit K 'deficiency' has been scapegoated.

Anyone diagnosed with a thrombophilia is very unlikely to be advised to give birth at home so there is a 'risk' of less thoughtful treatment. It is only people who are willing to fight OBs, registrars and doctors who are able to make decisions regarding their labour and birth. The vast majority of people follow their doctor's advice without questioning it.

I think a forum for clotting might be useful because the boards which currently offer support are very mainstream. I cannot believe how many times I have read people advocating that induction, epidural and caesarians are better/safer than a spontaneous labour, and that warfarin is not safe when breastfeeding.
post #49 of 54
Sorry, I lost track of this thread. ST, to answer your question, I have APS and Lupus Anti Coagulant. I did have a DVT and PE after knee surgery about 7 yrs ago. I also have rheumatoid arthritis so the autoimmune factor is in play there too.

I agree that a tribe for mamas with clotting disorders would be very helpful, I have to admit, when I was pregnant this time I had a heck of a time finding other moms here who had been through what I was going through. I had the support of my OB, who was awsome, but she admitted she was winging it a bit. Unfortunately the peri and the RE I had seen wanted to "try another pregnancy without treatment" He didn't care that dh and I had both decided we could only try one more time. We couldn't go through yet another loss--so this was our last kick at the can so to speak. I told my OB that I wanted to try everything that could help as long as the risks were not worse than loosing a baby. She agreed especially since my mother had severe pre-eclampsia, she felt that not treating for the clotting disorders left far too much chance of another failure. It would have been so nice to be able to get in touch with others here regarding the clotting issues. I belong to a yahoo group, but much of it is so mainstream.
To whoever mentioned about being screened for domestic abuse...:LOL, me too, it was worse too because I was so sick in the beginning that until they finally placed a pick line I'd had IV's in multiple spots on both arms--so my arms were bruised up as well. Poor dh, the looks he'd get if we went out to eat or something :LOL
post #50 of 54
Quote:
Originally Posted by jplain

In this case, if you give aspirin, the platelets are inherently less sticky. Adding more vitamin K to the system, even if that results in higher concentration of vit K dependent clotting factors, shouldn't make the platelets more sticky. The platelet stickiness is independent of the clotting factors. That stickiness is a property of the platelet itself.
-----
As an aside, very high doses of aspirin do directly interfere with the vit K dependent clotting pathway, although I'm not sure exactly which step is affected. I'm pretty sure it is moot though, because as a rule, high dosages of aspirin aren't given for clot prophylaxis.
Thank You jplain,
these 2 bits make it clear for me because I thought I remembered that aspirin could block vitamin K .


The study of vitamin K and the other functions in the body beyond clotting factors has grown in the last 10 years most of the research is related to aging. But the research also created a better way to quantify the amount of vitamin K in foods.In the US dietary intake is often not even at RDA levels. Even at levels that are sufficient to maintain normal blood coagulation may be sub-optimal for bone and artery health, and habitual low dietary intakes of vitamin K may have an adverse effect on bones and cardio vascular health. if you have healthy intestinal flora the production of vitamin K is low. also from more recent studies it was found that in hydrogenated oil there is a form of vitamin k called dihydrophylloquinone it is not well absorbed and seems to produce clotting factors but does not help with the other functions of phylloquinone no protection to bones or keeping the arteries free from calcification, dihydro goes where natural vitamin k goes in the body but is not converted to MK-4 like natural phylloquione does.
Breast milk readily delivers an increasing amount if mom increases her intake- since many nutrients are tightly regulated in breastmilk I think that there must be a reason that the body is delivering higher amounts in response to mom's diet.
post #51 of 54
I would be very interested in a forum for women with clotting disorders. Just starting to gather info on this and lord is it overwhelming. I don't know if I have this problem or not, but after 2 losses my ob/gyn had damn well better test for this. If not, outta my way because I'll find someone who will. :

Lisa
post #52 of 54
Thread Starter 
I just wanted to let you all know that I had my baby boy last Saturday- Sept 17th at 3:43 am and we are both healthy and happy. He was 6 lb 11 oz and is just a joy to behold.

I was induced at 37w2d because my bloodwork started looking not so great and we all agreed (my dh and I, my midwife and my perinatologist) that it would be better to induce rather than "wait and see" what happened.

After much discussion with the head of the nicu at the hosp and 2 hematologists, we decided to go ahead with the vit k shot and baby boy is doing well.
Thanks for all of your thoughts, info, suggestions and well wishes!
post #53 of 54
Congratulations and welcome to your little one!
post #54 of 54
Thread Starter 
thank you orangefoot!

i finally started this thread in fyt:
clotting disorder thread
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