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Efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome
L Barry Seltz1, Leigh Anne Bakel, Jennifer Tiehen
1Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USA. leonard.seltz@childrenscolorado.org
Insights
Clopidogrel treatment in children with diarrhea-associated hemolytic uremic syndrome showed comparable outcomes to untreated patients, with a potential for bleeding complications. This study explored the efficacy and safety of this platelet aggregation inhibitor.
Area of Science:
- Pediatric Nephrology
- Hematology
- Thrombotic Microangiopathies
Background:
- Hemolytic uremic syndrome (HUS) is a serious thrombotic microangiopathy.
- Clopidogrel, a platelet aggregation inhibitor, has not been previously studied for HUS treatment.
- Diarrhea-associated HUS is a common form in children.
Purpose of the Study:
- To evaluate the efficacy and safety of clopidogrel in pediatric patients with diarrhea-associated HUS.
- To compare outcomes of clopidogrel-treated children with those not receiving platelet aggregation inhibitors.
Main Methods:
- Retrospective chart review of children (≤18 years) hospitalized with diarrhea-associated HUS.
- Description of outcomes in clopidogrel-treated patients.
- Subgroup analysis comparing clopidogrel-treated patients to untreated patients.
Main Results:
- Of 72 children, 56% received clopidogrel; 88% received some platelet aggregation inhibitor.
- Clopidogrel-treated children had a median hospital stay of 9 days; 3 experienced bleeding complications.
- Subgroup analysis showed a shorter median dialysis duration (11 vs. 21 days) in clopidogrel-treated patients (P=0.04).
Conclusions:
- Clopidogrel treatment in pediatric diarrhea-associated HUS yielded outcomes comparable to untreated patients.
- Bleeding complications are a potential adverse event associated with clopidogrel use.
- Further research may clarify the role of clopidogrel in managing HUS.
Introduction:
Hemolytic uremic syndrome is a thrombotic microangiopathy. Clopidogrel, a recently developed platelet aggregation inhibitor, has not been previously reported as a treatment for this illness. Our study's objective was to explore the efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome.
Materials And Methods:
We performed a retrospective chart review of all children (≤ 18 years) hospitalized with diarrhea associated hemolytic uremic syndrome. Outcomes in clopidogrel treated children were described. In subgroup analysis, outcomes were compared to those untreated with platelet aggregation inhibitors.
Results:
Of 72 children with diarrhea associated hemolytic uremic syndrome, 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%). The median age of clopidogrel treated children was 5 years; 40% were male. Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53 × 10(3)/μL, and 2.3mg/dL respectively. Clopidogrel (median dose 1mg/kg/d) was given for a median of 4 days (range 1-15). Other therapies included erythropoietin (98%), red blood cell transfusions (80%), diuretics (58%), anti-hypertensive agents (45%), and dialysis (33%). The median hospital length of stay was 9 days (range 3-26). Three children had bleeding complications (epistaxis/hematemesis). The risk of chronic kidney disease was 5% and death 2.5%. In subgroup analysis, median duration of dialysis was 11 days in thirteen clopidogrel treated children compared to 21 days in five untreated patients (P=0.04).
Conclusions:
Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.
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