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Antiplatelet Therapy Monitoring in Neonates and Children
Joanna Yilin Huang1,2,3, Diajeng Ayesha Soeharto4,5, Ivan Damara4,5
1School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
Insights
Monitoring antiplatelet therapy in children lacks consensus on effective strategies and clinical benefits. Current methods lack uniformity and consistent correlation with outcomes, necessitating further research for pediatric patients.
Area of Science:
- Pediatric Pharmacology
- Hematology
- Clinical Chemistry
Background:
- Antiplatelet agents are crucial for preventing and treating thromboembolic disease in children.
- Effective monitoring strategies for pediatric antiplatelet therapy are not standardized.
- A complex pediatric population presents unique challenges for treatment monitoring.
Purpose of the Study:
- To review the current knowledge on antiplatelet therapy monitoring in pediatric patients.
- To identify commonly used monitoring methods and their application.
- To highlight the lack of consensus and areas for future research.
Main Methods:
- Systematic literature search across five major databases (PubMed, MEDLINE, SCOPUS, ScienceDirect, Cochrane) from January 2000 to October 2017.
- Included 20 studies: 14 cohort, 3 RCTs, 3 cross-sectional.
- Analyzed studies based on antiplatelet agents, monitoring methods, and outcomes.
Main Results:
- Eleven different monitoring tools were identified, including Light Transmission Aggregometry, Urinary Thromboxane, Thromboelastography with Platelet Mapping, and VerifyNow.
- Monitoring often relied on non-uniform laboratory cut-off values derived from adult studies.
- Associations between laboratory results, clinical outcomes, and gold standards were inconsistent.
Conclusions:
- There is a significant lack of consensus regarding the clinical benefits and optimal monitoring of antiplatelet therapy in children.
- Current monitoring practices lack standardization and consistent validation in pediatric populations.
- Further research is essential to establish effective and evidence-based monitoring strategies for pediatric antiplatelet treatment.
Abstract:
Antiplatelet agents are used for the prevention and treatment of thromboembolic disease in an increasingly complex population of pediatric patients. Despite their importance for clinical outcome, there is no consensus on the most effective monitoring strategies. This review describes the current state of knowledge focusing on antiplatelet therapy monitoring in children. The authors searched five databases (PubMed-NCBI, MEDLINE-OVID, SCOPUS-Elsevier, ScienceDirect, and Cochrane) from January 2000 to October 2017 using keywords selected a priori. Identified articles were sorted according to the antiplatelet agents administered, methods of antiplatelet monitoring, and outcome measures. Twenty studies were included, with 14 cohort studies, 3 randomized controlled trials, and 3 cross-sectional studies. Eleven different antiplatelet monitoring tools were used, with the most common being Light Transmission Aggregometry, Urinary Thromboxane, Thromboelastography with Platelet Mapping, and VerifyNow. In the majority of studies, antiplatelet therapy monitoring was used to describe adequacy or responsiveness to treatment based on laboratory cut-off values, which were not uniform and sourced from adult studies or extrapolated from test manuals. Several studies evaluated monitoring related to clinical outcome or adjusted therapy to reach predefined therapeutic targets. There was no single laboratory method found to be distinctly better for monitoring antiplatelet treatment. Associations between laboratory assays and clinical outcomes or assays and gold standard measurements were highly inconsistent. The current literature lacks consensus on clinical benefits and measurable effects of monitoring antiplatelet therapy in pediatric patients. This review highlights important areas for research required to determine the value of antiplatelet therapy monitoring in children.
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