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Survey of oral anticoagulant treatment in children
D I Evans1, M Rowlands, L Poller
1Royal Manchester Children's Hospital.
Insights
Pediatric oral anticoagulant therapy in the UK is primarily for artificial heart valves. Target International Normalized Ratio (INR) levels for children are similar to adult recommendations and appear safe, despite inconsistent warfarin dosing.
Area of Science:
- Pediatric Hematology
- Cardiology
- Pharmacology
Background:
- Oral anticoagulants are crucial for managing thromboembolic conditions in children.
- Understanding current treatment practices and control measures is essential for optimizing pediatric anticoagulation.
Purpose of the Study:
- To investigate the patient populations receiving oral anticoagulants in the UK.
- To determine the methods used for controlling anticoagulation therapy in pediatric patients.
Main Methods:
- Two distinct questionnaires were distributed to general hematologists and pediatric cardiologists/cardiac surgeons.
- Data was collected on patient demographics, indications for anticoagulation, target International Normalized Ratio (INR) ranges, and monitoring methods.
Main Results:
- Most pediatric patients received anticoagulants due to artificial cardiac valve replacement.
- Target INR ranges varied: 2.73-4.0 for heart valves and 2.1-3.25 for venous thrombosis.
- In a subset of 68 children, treatment resulted in two major bleeds and two thrombotic episodes, with 78.8% monitored via venous prothrombin time.
Conclusions:
- Maintenance anticoagulation levels in children are comparable to British Society for Hematology adult guidelines (3.0-4.5).
- These levels appear to be safe and effective for pediatric patients.
- Significant inconsistency was observed in warfarin induction dosing regimens.
Aims:
To find out which children are treated with oral anticoagulants and how their treatment is controlled in the United Kingdom.
Methods:
Two questionnaires were used. The first was sent to general haematologists and the other to paediatric cardiologists and cardiac surgeons.
Results:
There were 273 (58%) replies to the first questionnaire. Most children were treated because of artificial cardiac valve replacement. The mean target International Normalised Ratio (INR) used was 2.73 to 4.0 for children with heart valves and 2.1 to 3.25 for children with venous thrombosis. The second questionnaire elicited replies from 11 of 22 cardiac centres. The mean target INR used for children with cardiac valves ranged from 2.59-3.77. Of 68 children covered in the survey, there have been two major bleeds and two thrombotic episodes: 78.8% of children were controlled with a venous prothrombin time and 21.2% with a capillary test. There was no consistency in the dose regimens used for the induction of oral anticoagulant treatment with warfarin.
Conclusions:
The levels of anticoagulation used for maintenance are similar to those recommended by the British Society for Haematology for adults (3.0 to 4.5). They seem to be safe for children too.