Christina Smith, PharmD, BCCCP, BCPPS
Pediatric Clinical Pharmacist
Seattle Childrens Hospital
Seattle, Washington
Disclosure information not submitted.
Caroline Sierra, PharmD, BCPPS
Assistant Professor
Loma Linda University School of Pharmacy, United States
Disclosure information not submitted.
Ryan Valencia
Pharmacy Student
Loma Linda University School of Pharmacy, United States
Disclosure information not submitted.
.jpg "Merrick Lopez, MD photo")
Title: The Use of Vitamin K for Coagulopathy in Critically Ill Children
Introduction: Coagulopathy is associated with increased mortality in children treated in the intensive care setting. Recommended management of vitamin K-deficient coagulopathy is vitamin K (VK) administration. However, limited data support this practice outside reversal of VK antagonists. The goal of this study was to evaluate the effectiveness and safety of VK administration for coagulopathy in critically ill children and determine a relationship between VK 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 VK for acute coagulopathy in the pediatric intensive care unit between January 2013 and January 2021. Patients who receiving VK antagonists were excluded. Effectiveness data included change in PT/INR after VK administration. Safety data included incidence of hypersensitivity reaction or anaphylaxis. Change in PT/INR was analyzed using Student’s t-test (α=0.05). Regression analysis was used to examine the relationship between VK dose and INR change accounting for receipt of fresh frozen plasma (FFP).
Results: A total of 223 patients (median age 3.9 years, range 22 days-17.8 years) received VK. A median of 3 doses (range 1-14) and 0.14 mg/kg (range 0.02-1.24 mg/kg) were given, most frequently intravenously (94%). The most common admitting diagnoses were infection/sepsis (28%) and trauma (15%). Neurologic conditions were the most common comorbidity (41%). Most patients (98%) had at least one risk factor for VK deficiency, the most common being nothing by mouth status (80%) followed by receipt of antimicrobials (77%). Less than half (40%) of patients received FFP within 12 hours of VK. Mean PT/INR was 21.1/2.0 prior to VK administration. After the first dose of VK, the PT and INR decreased by 4.2 (SD=8.33, p< 0.001) and 0.5 points (SD=0.98, p< 0.001) to a mean of 16.9 and 1.6, respectively. No hypersensitivity/anaphylaxis occurred following VK administration. No linear relationship was found between VK dose administered and change in PT/INR.
Conclusions: Administration of VK is an effective and safe treatment for VK deficient coagulopathy in critically ill pediatric patients. Further study is needed to determine if a relationship between VK dose and PT/INR change exists.