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Survey results: characterization of direct thrombin inhibitor use in pediatric patients
1Department of Pharmacy, Children's Mercy Hospital and Clinics, Kansas City, Missouri.
Insights
Pediatric use of direct thrombin inhibitors (DTIs) varies widely, with no consistent dosing or titration strategies across institutions. Further research is needed to establish standardized pediatric DTI guidelines.
Area of Science:
- Pediatric pharmacology
- Cardiovascular therapeutics
- Pharmacometrics
Background:
- Direct thrombin inhibitors (DTIs) are crucial anticoagulants.
- Limited data exists on their use in pediatric populations.
- Standardized dosing and titration recommendations are lacking for pediatric patients.
Purpose of the Study:
- To characterize current DTI utilization in pediatric care.
- To identify variations in DTI prescribing practices.
- To inform the design of future pediatric DTI studies.
Main Methods:
- Multicenter descriptive survey of 56 US institutions.
- Survey distributed via email to the Pediatric Pharmacy Advocacy Group.
- Descriptive statistics analyzed using Microsoft Excel 2007.
Main Results:
- Argatroban is the most common DTI available (~80%).
- DTIs are used infrequently (2-4 times/year or less) in most institutions.
- Significant heterogeneity exists in DTI dosing and titration protocols.
Conclusions:
- Pediatric DTI use is inconsistent across institutions.
- Recent studies and updated guidelines may promote more uniform practices.
- Standardized DTI dosing is essential for safe and effective pediatric anticoagulation.
Objectives:
The objective of this multicenter survey is to characterize the use of direct thrombin inhibitors (DTIs) in the pediatric population. The results of this survey may be used to design a prospective multicenter study with the ultimate goal of developing a dosing/titration recommendation for the use of DTIs in the pediatric population.
Methods:
This is a multicenter, descriptive study to survey hospitals around the country regarding the use of DTIs (argatroban, bivalirudin, and lepirudin) in the pediatic population. Institutional review board approval was obtained. The survey consisted of 42 questions and was designed utilizing Survey Monkey. The survey was emailed to members of the Pediatric Pharmacy Advocacy Group. Listserv members who responded to the survey within 4 weeks of when the survey was emailed were included in the study. Descriptive statistics were performed utilizing Microsoft Excel 2007.
Results:
Responses were obtained from 56 institutions from 29 states in the United States. Multiple agents are available on formulary with argatroban being the most common (~80%). The large majority of institutions (41.1%) utilize DTIs 2 to 4 times a year with an additional 33.9% utilizing them less than twice a year. There is no consistent approach to dosing and titration amongst pediatric institutions.
Conclusions:
There are a wide variety of methods used by pediatric institutions with regard to dosing and titration of DTIs. Recently published prospective studies and package insert updates should help guide practitioners toward a more consistent approach to dosing of these high-risk medications.
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