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Decreased concentrations of vitamin K and vitamin K hydroquinone in the tissue , results in inefficient carboxylation reaction catalysed by glutamyl carboxylase .
This results in the production of clotting factor with inadequate gamma carboxy glutamate ( Gla ) . Without Gla on the amino terminal of these factors , they no longer bind stably to the blood vessel endothelium and cannot activate clotting and allow formation of a clot during tissue injury.

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