TY - JOUR
T1 - Vitamin K deficiency bleeding in children with cholestatic liver disease
T2 - a systematic review and meta-analysis
AU - Sakwit, Anusak
AU - Pongphitcha, Pongpak
AU - Komvilaisak, Patcharee
AU - Ochiai, Masayuki
AU - Takahashi, Daijiro
AU - Suga, Shutaro
AU - Chuansumrit, Ampaiwan
AU - Betensky, Marisol
AU - Pereira, Stephen P.
AU - Afzal, Amber
AU - van Ommen, C. Heleen
AU - Goldenberg, Neil
AU - Rattanasiri, Sasivimol
AU - Sirachainan, Nongnuch
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/3
Y1 - 2025/3
N2 - Vitamin K deficiency (VKD) in cholestatic liver disease affects up to 23% of pediatric patients. While several vitamin K (VK) prophylaxis regimens have been proposed, optimal therapeutic strategies remain undefined. The study aimed to identify the most effective VK prophylaxis for children with cholestatic liver disease. We conducted a systematic review of articles focusing on studies of children aged <18 years with cholestatic liver disease who reported outcomes of either VKD or vitamin K deficiency bleeding (VKDB) after VK prophylaxis. The articles were sourced from PubMed, Scopus, and Embase. A meta-analysis was performed to determine the prevalence of VKD and the efficacy of each prophylactic protocol in preventing VKD/VKDB. The study was registered on PROSPERO (CRD 42021270048). Of the 889 articles, 37 were selected (2 comparative studies, 6 noncomparative studies, and 29 case reports/series). The results from the comparative studies indicated a lower incidence of VKD in the parenteral than that in the oral VK. The meta-analysis of the noncomparative studies showed the prevalence of VKD in high prothrombin induced by vitamin K absence-II group was 56% (95% CI, 45%-68%; I2 = 0.0%; H2 = 1.0; Q test: χ2 = 1.93; P = .38) and a prevalence of VKD in abnormal coagulation test was 10% (95% CI, 5%-14%; I2 = 0%, H2 = 1.0; Q test: χ2 = 0.82; P = .66), respectively. Among the 3 administrative routes, the analysis from case reports/series showed the median onset of VKDB in cholestatic infants was the earliest in the oral (44.5 days; IQR, 13.0-240.0 days) compared with intramuscular (86.0 days; IQR, 36.0-120.0) and intravenous routes and intravenous (97.0 days; IQR, 74.0-120.0 days) VK prophylaxis. Available studies to determine the optimal route of VK administration in children with cholestatic liver disease were limited. The result from the review indicated that parenteral VK demonstrated a noticeable advantage over oral VK for VKD/VKDB prevention in cholestatic children.
AB - Vitamin K deficiency (VKD) in cholestatic liver disease affects up to 23% of pediatric patients. While several vitamin K (VK) prophylaxis regimens have been proposed, optimal therapeutic strategies remain undefined. The study aimed to identify the most effective VK prophylaxis for children with cholestatic liver disease. We conducted a systematic review of articles focusing on studies of children aged <18 years with cholestatic liver disease who reported outcomes of either VKD or vitamin K deficiency bleeding (VKDB) after VK prophylaxis. The articles were sourced from PubMed, Scopus, and Embase. A meta-analysis was performed to determine the prevalence of VKD and the efficacy of each prophylactic protocol in preventing VKD/VKDB. The study was registered on PROSPERO (CRD 42021270048). Of the 889 articles, 37 were selected (2 comparative studies, 6 noncomparative studies, and 29 case reports/series). The results from the comparative studies indicated a lower incidence of VKD in the parenteral than that in the oral VK. The meta-analysis of the noncomparative studies showed the prevalence of VKD in high prothrombin induced by vitamin K absence-II group was 56% (95% CI, 45%-68%; I2 = 0.0%; H2 = 1.0; Q test: χ2 = 1.93; P = .38) and a prevalence of VKD in abnormal coagulation test was 10% (95% CI, 5%-14%; I2 = 0%, H2 = 1.0; Q test: χ2 = 0.82; P = .66), respectively. Among the 3 administrative routes, the analysis from case reports/series showed the median onset of VKDB in cholestatic infants was the earliest in the oral (44.5 days; IQR, 13.0-240.0 days) compared with intramuscular (86.0 days; IQR, 36.0-120.0) and intravenous routes and intravenous (97.0 days; IQR, 74.0-120.0 days) VK prophylaxis. Available studies to determine the optimal route of VK administration in children with cholestatic liver disease were limited. The result from the review indicated that parenteral VK demonstrated a noticeable advantage over oral VK for VKD/VKDB prevention in cholestatic children.
KW - bleeding
KW - children
KW - cholestatic liver disease
KW - prophylaxis
KW - vitamin K
UR - https://www.scopus.com/pages/publications/105004275606
U2 - 10.1016/j.rpth.2025.102847
DO - 10.1016/j.rpth.2025.102847
M3 - Review article
C2 - 40470336
AN - SCOPUS:105004275606
SN - 2475-0379
VL - 9
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 3
M1 - 102847
ER -