Vitamin K deficiency bleeding in children with cholestatic liver disease: a systematic review and meta-analysis
Issued Date
2025-03-01
Resource Type
eISSN
24750379
Scopus ID
2-s2.0-105004275606
Journal Title
Research and Practice in Thrombosis and Haemostasis
Volume
9
Issue
3
Rights Holder(s)
SCOPUS
Bibliographic Citation
Research and Practice in Thrombosis and Haemostasis Vol.9 No.3 (2025)
Suggested Citation
Sakwit A., Pongphitcha P., Komvilaisak P., Ochiai M., Takahashi D., Suga S., Chuansumrit A., Betensky M., Pereira S.P., Afzal A., van Ommen C.H., Goldenberg N., Rattanasiri S., Sirachainan N. Vitamin K deficiency bleeding in children with cholestatic liver disease: a systematic review and meta-analysis. Research and Practice in Thrombosis and Haemostasis Vol.9 No.3 (2025). doi:10.1016/j.rpth.2025.102847 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/110068
Title
Vitamin K deficiency bleeding in children with cholestatic liver disease: a systematic review and meta-analysis
Author's Affiliation
UCL Division of Medicine
Washington University School of Medicine in St. Louis
Srinagarind Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Erasmus MC Sophia Children’s Hospital
University of Occupational and Environmental Health School of Medicine
Kyushu University
Johns Hopkins University School of Medicine
Fukuda Hospital
Washington University School of Medicine in St. Louis
Srinagarind Hospital
Faculty of Medicine Ramathibodi Hospital, Mahidol University
Erasmus MC Sophia Children’s Hospital
University of Occupational and Environmental Health School of Medicine
Kyushu University
Johns Hopkins University School of Medicine
Fukuda Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
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.