The use of vitamin K for coagulopathy in critically ill children

ABSTRACT

Objectives

Coagulopathy is associated with increased mortality in children in the intensive care unit (ICU). Recommended management of vitamin K-deficient coagulopathy is vitamin K administration. The goal of this study was to evaluate vitamin K administration for coagulopathy in critically ill children and determine a relationship between vitamin K dose and change in prothrombin time (PT) and international normalized ratio (INR).

Methods

This retrospective cohort study reviewed electronic medical records of patients ≤17 years who received vitamin K for acute coagulopathy in the pediatric ICU from January 2013 to January 2021. Patients receiving vitamin K antagonists were excluded. Effectiveness data included change in PT/INR after vitamin K administration. Safety data included incidence of hypersensitivity or anaphylaxis.

Results

A total of 310 patients (median age 6.8 years, range 22 days-17.7 years) received vitamin K. A median of three doses (range 1–8) and 0.14 mg/kg per dose (range 0.09–0.22 mg/kg) were given, most frequently intravenously (892/949, 94%). Most patients (304/310, 98%) had at least one risk factor for vitamin K deficiency. Mean PT/INR was 21.5/2.1 prior to vitamin K administration, which decreased by 4.4 (SD = 9.0, 95% CI 16.011 to 18.015, p < 0.001) and 0.5 (SD = 1.0, 95% CI 1.490 to 1.705, p < 0.001) to means of 17.0 and 1.6, respectively, after the first vitamin K dose. No linear relationship was found between vitamin K dose and change in PT/INR. No hypersensitivity or anaphylaxis occurred following vitamin K administration; 27% (84/310) of patients died.

Conclusions

Administration of vitamin K is effective and safe for the management of vitamin K-deficient coagulopathy in critically ill pediatric patients. Further study is needed to determine a relationship between vitamin K dose and change in PT/INR.

KEYWORDS:

• Pediatrics
• prothrombin time
• international normalized ratio
• pediatric intensive care unit
• vitamin K

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge the contributions of Ashley Tuttle and Haneul Kim to the data collection process. This work has been presented as a poster at the American Society of Health-System Pharmacists Midyear Clinical Meeting in December 2021 and as a platform presentation at the Society of Critical Care Medicine Critical Care Congress in February 2022.

Author contributions

CJ Smith – conceptualization, methodology, formal analysis, data curation, writing – original draft, writing – review and editing, visualization; R Valencia – methodology, formal analysis, investigation, writing – original draft, writing – review and editing; CM Sierra – methodology, investigation, writing – original draft, writing – review and editing, supervision, project administration; M Lopez – methodology, writing – review and editing, supervision.

Additional information

Funding

This paper was not funded.