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Anticoagulation Therapies in Children

Guy Young1

  • 1Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Southern California Keck School of Medicine, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.

Pediatric Clinics of North America
|November 28, 2017
PubMed

Insights

Pediatric venous thromboembolism (VTE) is rising, increasing the use of anticoagulation. Alternative anticoagulants show promise to overcome limitations of standard agents, potentially replacing them in pediatric care.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Increasing incidence of pediatric venous thromboembolism (VTE).
  • Widespread use of anticoagulation in pediatric patients.
  • Classification of pediatric antithrombotic drugs into standard and alternative agents.

Purpose of the Study:

  • To review standard and alternative anticoagulant agents used in pediatrics.
  • To discuss the limitations of current standard anticoagulants.
  • To explore the future role of alternative anticoagulants in pediatric VTE management.

Main Methods:

  • Literature review of standard and alternative anticoagulants in pediatric use.
  • Analysis of pharmacokinetic properties, therapeutic drug monitoring, administration frequency, efficacy, and adverse effects.
  • Evaluation of recent prospective clinical trial data for alternative agents.

Main Results:

  • Standard anticoagulants present significant limitations including variable pharmacokinetics and challenges in drug monitoring.
  • Adverse effects, administration frequency, and efficacy issues are noted with standard agents.
  • Alternative anticoagulants possess improved properties compared to standard agents.

Conclusions:

  • The limitations of standard anticoagulants are driving the exploration of alternative agents.
  • Alternative anticoagulants are expected to see increased use in pediatric practice.
  • Improved properties and clinical data suggest alternative anticoagulants may gradually replace standard agents for pediatric VTE.

Keywords:
AnticoagulationArgatrobanBivalirudinChildrenFondaparinuxHeparinLow-molecular-weight heparinWarfarin

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