(1)   A 45 years old man is scheduled for an elective Roux en Y gastrojejunostomy. He is an alcohol abuser and has chronic alcoholic hepatitis. His liver enzymes are elevated and his prothrombin time is double the normal time. Preoperative treatment of his coagulopathy includes:

 (a)    Injection Vitamin B12 intravenously

(b)   Branched chain amino acids intravenous continuous infusion

(c)    Oral Vitamin K in a dose of 10mg

(d)   Platelet transfusion.

 Answer: The answer is (c). A single oral dose of Vitamin K in a dose of 10mg is sufficient to correct coagulation anomalies due to Vitamin K deficiency as happens in hepatic dysfunction. If the coagulation abnormality is not corrected by Vitamin K, fresh frozen plasma needs to be given. Plasma exchange can be used for refractory coagulopathy.

In patients who need to be anticoagulated after surgery (e.g. atrial fibrillation patient), the dose is halved.