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The use of vitamin K for coagulopathy in critically ill children

Christina J Smith1, Ryan Valencia2, Caroline M Sierra3

  • 1Department of Pharmacy, Loma Linda University Children's Hospital, Loma Linda, CA, USA.

Hospital Practice (1995)
|November 7, 2023
PubMed

Insights

Vitamin K effectively treats coagulopathy in critically ill children, showing significant improvements in prothrombin time (PT) and international normalized ratio (INR). This treatment is safe, though no dose-response relationship was identified.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Pharmacology

Background:

  • Coagulopathy in pediatric intensive care unit (ICU) patients is linked to higher mortality rates.
  • Vitamin K administration is the standard treatment for vitamin K-deficient coagulopathy.
  • Evaluating vitamin K's efficacy and safety in critically ill children is crucial.

Purpose of the Study:

  • To assess the effectiveness of vitamin K in treating coagulopathy in critically ill children.
  • To determine if a relationship exists between vitamin K dosage and changes in prothrombin time (PT) and international normalized ratio (INR).

Main Methods:

  • Retrospective cohort study of patients aged ≤17 years in a pediatric ICU from 2013-2021.
  • Excluded patients receiving vitamin K antagonists.
  • Analyzed changes in PT/INR and incidence of hypersensitivity/anaphylaxis post-vitamin K administration.

Main Results:

  • 310 patients received vitamin K, with a median of three doses at 0.14 mg/kg per dose.
  • Mean PT/INR decreased significantly after the first vitamin K dose (p < 0.001).
  • No linear relationship was observed between vitamin K dose and PT/INR changes; no adverse events reported, but 27% mortality.

Conclusions:

  • Vitamin K is an effective and safe treatment for vitamin K-deficient coagulopathy in critically ill pediatric patients.
  • Further research is required to establish a dose-response relationship between vitamin K and PT/INR.
  • Despite treatment effectiveness, high mortality underscores the severity of critical illness in this population.
Abstract

Keywords:
Pediatricsinternational normalized ratiopediatric intensive care unitprothrombin timevitamin K

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