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Anticoagulant therapy in pediatrics

Mariam K Dabbous1, Fouad R Sakr2, Diana N Malaeb3

  • 1Department of Pharmacy Practice, School of Pharmacy, Lebanese International University, Beirut, Lebanon.

Journal of Basic and Clinical Pharmacy
|July 18, 2014
PubMed

Insights

Pediatric venous thromboembolism and anticoagulant use are rising. Low Molecular Weight Heparin (LMWH) and Direct Thrombin Inhibitors (DTI) offer safer alternatives to Unfractionated Heparin (UH) due to fewer side effects and better profiles.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Thrombosis Management

Background:

  • Thromboembolic episodes occur in both children and adults, with increasing incidence in pediatric venous thromboembolism and anticoagulant use.
  • Unfractionated Heparin (UH) is a standard anticoagulant but faces limitations in pediatric use, including Heparin Induced Thrombocytopenia (HIT) and anaphylaxis.
  • Existing anticoagulants present challenges for pediatric application, necessitating safer and more effective alternatives.

Purpose of the Study:

  • To delineate the distinctions between adult and pediatric thromboembolism.
  • To conduct a comprehensive review of current anticoagulant therapies used in pediatrics.
  • To compare and contrast traditional and novel anticoagulant treatments for pediatric patients.

Main Methods:

  • Literature review focusing on pediatric thromboembolism and anticoagulant pharmacology.
  • Comparative analysis of Unfractionated Heparin (UH), Low Molecular Weight Heparin (LMWH), and Direct Thrombin Inhibitors (DTI).
  • Evaluation of anticoagulants based on pharmacological action, dosing, adverse reactions, pharmacokinetics, interactions, and clinical parameters.

Main Results:

  • Low Molecular Weight Heparin (LMWH) emerges as a safer and effective alternative to UH in pediatric populations, owing to its favorable pharmacokinetic and side-effect profile.
  • Direct Thrombin Inhibitors (DTI) represent a promising class of anticoagulants with potential advantages over existing therapies.
  • Significant differences exist in the presentation and management of thromboembolism between adult and pediatric patients.

Conclusions:

  • LMWH and DTIs offer improved safety and efficacy profiles compared to UH for pediatric anticoagulation.
  • Understanding the nuances of pediatric thromboembolism is crucial for optimizing treatment strategies.
  • This review provides a foundation for informed clinical decisions regarding anticoagulant selection in children.

Keywords:
Direct thrombin inhibitorslow molecular weight heparinpediatricsthromboembolic disordersunfractionated heparinvitamin K antagonist

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