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The use of low molecular weight heparin in pediatric patients: a prospective cohort study
D Dix1, M Andrew, V Marzinotto
1Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Low molecular weight heparins (LMWH) are safe and effective for treating and preventing blood clots in children. This study found high success rates with minimal adverse events, supporting further research.
Area of Science:
- Pediatric Hematology
- Pharmacology
- Thrombosis Management
Background:
- Low molecular weight heparins (LMWHs) offer advantages over traditional anticoagulants like unfractionated heparin and warfarin.
- These advantages include predictable pharmacokinetics, reduced need for monitoring, and ease of subcutaneous administration.
- The safety and efficacy of LMWHs in pediatric populations require thorough investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of LMWHs in pediatric patients.
- To assess the clinical outcomes of LMWH use for both treatment and prophylaxis of thromboembolic events (TEs) in children.
Main Methods:
- A prospective cohort study was conducted at the Hospital for Sick Children, Toronto.
- The study monitored children treated with the LMWH enoxaparin from March 1994 to July 1997.
- Data collected included treatment courses for TE management and prophylaxis.
Main Results:
- 146 treatment courses and 31 prophylaxis courses of LMWH were administered.
- Clinical resolution of TEs was achieved in 94% of children receiving therapeutic LMWH doses.
- 96% of children on prophylactic LMWH doses experienced no recurrent or new TEs; major bleeding occurred in 5% of therapeutic cases.
Conclusions:
- LMWH demonstrates efficacy and safety for both the management and prophylaxis of TEs in children.
- The findings support the need for a randomized controlled trial to compare LMWH with standard anticoagulant therapies in pediatric TEs.
Objective:
Low molecular weight heparins (LMWHs) offer several advantages over standard anticoagulant therapy (unfractionated heparin/warfarin) including predictable pharmacokinetics, minimal monitoring, and subcutaneous administration. Our objective was to determine the safety and efficacy of LMWHs in children.
Methods:
A prospective cohort of children treated with the LMWH enoxaparin (Rhone Poulenc Rorer) was monitored at the Hospital for Sick Children, Toronto, Canada, from March 1994 until July 1997.
Results:
There were 146 courses of LMWH administered for treatment and 31 courses for prophylaxis of thromboembolic events (TEs). Clinical resolution of TEs occurred in 94% of children receiving therapeutic doses of LMWH, and 96% of children receiving prophylactic doses of LMWH had no symptoms of recurrent or new TEs. Major bleeding occurred in 5% of children receiving therapeutic doses. Recurrent or new TEs occurred in 1% and 3% of children receiving therapeutic and prophylactic doses of LMWH, respectively.
Conclusion:
LMWH appears to be efficacious and safe for both management and prophylaxis of TEs. The results of this cohort study justify a randomized controlled trial comparing LMWH with standard therapy for the management of TEs in children.