Comparison of Vitamin K Doses in Patients With Larger Burn Injuries

Study Overview
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Brief Summary
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The use of Vitamin K in treating bleeding diatheses is well documented and accepted as standard of care, as is the effect of Vitamin K on calcium and bone metabolism. In the treatment of larger burns however, there is a paucity of available literature related to optimal daily dosing, goals of therapy and potential complications. This study aims to identify any potential issues arising from the administration of a standard of care dose in an historical cohort of subjects with larger burns to a prospective patient population given a decreasing dose during their intensive care unit (ICU) stay.

Detailed Description
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This will be a prospective, single-center study. Eligible subjects will present with a minimum 20% Total Body Surface Area (TBSA) burn injury and expected to receive the standard dose of intravenous Vitamin K (10mg/day). Exclusion criteria will include any patient admitted with a history of, or having present at baseline: bleeding disorders, thrombocytopenia, coagulopathy, or liver dysfunction (MELD Score ≥20). Subjects who are moribund, or in the opinion of the investigator, not expected to survive will be excluded, as well as burns induced as a result of a suicide attempt. The study will enroll approximately 25 subjects in the prospective arm and 25 subjects will be matched from our medical record data base to the basic subject criteria for the chart review portion of the study. Study duration will be 90 days. The research foundation will request exemption, waiver of HIPAA (Health Insurance Portability and Accountability Act) authorization and waiver of informed consent for the data collection /cohort portion of the study as only burn injury demographics, lab results and dosing regimen will be collected. No protected health information (PHI) will be recorded on patients identified for the cohort arm of the study.

Official Title
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Comparison of a Decreasing Dose of Daily Intravenous Vitamin K to a Single Dose Given as Standard of Care to an Historical Cohort in Subjects With Larger Burns

Conditions
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Burns

Intervention / Treatment
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* Drug: Vitamin K


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The Subject: is anticipated to be hospitalized for the duration of treatment. is ≥18 years of age. or their legally authorized representative is able to provide informed consent. has been diagnosed with at least 20%TBSA thermal, chemical, or electrical burn. has a negative urine or serum pregnancy test at screening (if female and has potential for pregnancy)? is expected to receive the standard of care dosing of intravenous Vitamin K (10g/day). Exclusion Criteria: The Subject: has a history or, or has present at baseline any of the following: bleeding disorders thrombocytopenia coagulopathy liver failure (MELD -Model for end stage liver disease score ≥20) is already therapeutically anticoagulated for PE, DVT, etc. is participating in another interventional clinical trial for the duration of the study. is moribund, or in the opinion of the investigator is not expected to survive. has a burn injury sustained as a result a suicide attempt. Historical Cohort Inclusion/Exclusion All criteria will be the same except there will be no informed consent requirement. The data collection portion in the historical cohort will be to match burn size, type and etiologies and to collect lab results and other outcomes as specified in the study objectives. No PHI will be collected or shared. Additionally, only patients that received intravenous Vitamin K 10m/day for at least 14 days will be chosen for data collection. Every attempt will be made to match study drug duration (90days) as closely as possible.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Single-center, prospective interventional study to compare a decreasing dose of daily Vitamin K to a matched retrospective cohort
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Decreasing Daily Dose of Vitamin K<br>This group of patients will receive a decreasing dose of Vitamin K IV: Days 1-2 = 10mg/day (standard of care) Days 3-4 = 5mg/day Days 5-90 (or date of discharge, death, etc) = 2mg/day | Drug: Vitamin K<br>* Administration of intravenous Vitamin K in doses of 10mg/day, 5mg/day or 2mg/day<br>|
| Active Comparator: Standard of Care Dose of Vitamin K<br>This group of patients will be reviewed retrospectively and would have received Vitamin K IV at 10mg/day during their entire hospital course | Drug: Vitamin K<br>* Administration of intravenous Vitamin K in doses of 10mg/day, 5mg/day or 2mg/day<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome for the study will be rate of DVT occurrence | This outcome will be measured in patients with larger burn % total body surface area (TBSA) burn injury receiving Vitamin K 10mg/day with a decreasing dose over 5 days and maintaining a lower daily dose, versus an historical cohort that received intravenous Vitamin K 10m/day during their entire intensive care unit (ICU) stay. | 90 days or the study will end at time of discharge or death. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The secondary outcome for this study will be total number of blood products transfused (Fresh Frozen Plasma - FFP and Packed Red Blood Cells - PRBCs. | This outcome will be measured in patients with larger burn % TBSA receiving Vitamin K 10mg/day with a decreasing dose over 5 days and maintaining a lower daily dose, versus an historical cohort that received intravenous Vitamin K 10m/day during their entire ICU stay | 90 days or the study will end at time of discharge or death. | 
| The secondary outcome for this study will be comparison of coagulopathy patterns | This outcome will be measured in patients with larger burn % TBSA receiving Vitamin K 10mg/day with a decreasing dose over 5 days and maintaining a lower daily dose, versus an historical cohort that received intravenous Vitamin K 10m/day during their entire ICU stay as evidenced by changes in: (Protime - PT, Partial Thromboplastin Time - PTT and International Normalized Ration - INR, liver function abnormalities (Serum glutamic pyruvic transaminase - SGPT, Serum glutamic oxaloacetic transaminase - SGOT, Albumin , Bilirubin). | 90 days or the study will end at time of discharge or death. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vitamin K