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Bivalirudin for anticoagulation in children
Sobharani Rayapudi1, Adalberto Torres, Girish G Deshpande
1University of Illinois College of Medicine, Peoria, Illinois 61614, USA.
Pediatric Blood & Cancer
|September 27, 2008
Summary
Bivalirudin effectively treated thrombosis in pediatric patients, showing thrombus regression in 10 of 10 cases. This direct thrombin inhibitor offers a promising alternative to heparin, with good tolerability observed in children.
Area of Science:
- Pediatric Thrombosis Management
- Anticoagulant Therapy in Children
Background:
- Pediatric thromboembolism often treated with unfractionated heparin (UH) or low molecular weight heparin (LMWH), both dependent on antithrombin (AT).
- Heparin-induced thrombocytopenia (HIT) is a significant risk associated with heparin use in pediatric patients.
- Direct thrombin inhibitors, such as bivalirudin, present a potential alternative for treating pediatric thrombosis.
Purpose of the Study:
- To assess the efficacy and safety of bivalirudin in pediatric patients diagnosed with thrombosis.
- To evaluate bivalirudin as an alternative anticoagulant therapy in children.
Main Methods:
- Retrospective review of 16 pediatric patients treated with bivalirudin for thrombosis or its prevention.
- Administration of a bolus dose followed by a continuous infusion, titrated to maintain activated partial thromboplastin time (aPTT) at 1.5-2.5 times baseline.
- Correlation analysis between bivalirudin infusion rate and aPTT, and ultrasonographic assessment of thrombus regression.
Main Results:
- A positive correlation was observed between the bivalirudin infusion rate and aPTT in twelve patients.
- Ultrasonographic evidence of thrombus regression was achieved in all 10 patients assessed at 72 hours.
- One patient experienced hematuria following urethral catheterization, indicating a potential adverse event.
Conclusions:
- Bivalirudin demonstrated effectiveness and was well-tolerated in the studied pediatric population.
- Further research is warranted to fully establish the safety and efficacy profile of bivalirudin in pediatric patients.
- Bivalirudin shows promise as a safe and effective anticoagulant for pediatric thrombosis.
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