Antithrombotic therapy in children and adolescents
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Long-term antithrombotic therapy with acenocoumarol plus aspirin is safe and effective for children and adolescents. This treatment significantly reduces thrombo-embolic events, with a low incidence of bleeding complications.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Long-term antithrombotic therapy is crucial for pediatric patients with prosthetic heart valves.
- Managing anticoagulation in children presents unique challenges due to physiological changes.
Purpose of the Study:
- To evaluate the safety and efficacy of long-term antithrombotic therapy (acenocoumarol plus aspirin) in pediatric patients with prosthetic heart valves.
- To assess the incidence of thrombo-embolic events and bleeding complications.
Main Methods:
- A retrospective analysis of 31 children and adolescents (5 months to 16 years) receiving long-term acenocoumarol plus aspirin therapy.
- Follow-up duration of 1336 months, monitoring for embolic episodes and bleeding events.
Main Results:
- The overall incidence of embolic episodes was 1.49/1000 patient-months, with 0.74/1000 patient-months in adequately anticoagulated patients.
- 93.7% of patients remained free of thrombo-embolic accidents up to 96 months.
- Minor hemorrhage incidence was 1.49/1000 patient-months; only one major bleeding episode occurred.
Conclusions:
- Long-term antithrombotic therapy with acenocoumarol plus aspirin is well-tolerated and effective in pediatric patients with prosthetic heart valves.
- The combination therapy demonstrates a favorable safety profile with a low risk of major bleeding.
- Management of this therapy in children is feasible, highlighting its clinical utility.
Abstract:
This report documents our experience with long term antithrombotic therapy (acenocoumarol plus aspirin) in 31 children and adolescents, from 5 months to 16 years of age. The valves replaced were mitral in 20 patients, aortic in 4, mitral-aortic in 4 and tricuspid in 3; the overall follow-up time was of 1336 months. Anticoagulant requirement in each children was not in correlation with age, but a significant increase (p less than 0.01) was found in association with sexual development. Our total incidence of embolic episodes was 1.49/1000 patient-months. The embolic incidence on adequate anticoagulated patients was 0.74/1000 patient-months and 93.7% of all patients were free of thrombo-embolic accidents up to 96 months of follow-up. Minor haemorrhage in relation to an excess of anticoagulant was 1.49/1000 patient-months. There has been only one major bleeding episode associated with severe sepsis, with an incidence of 0.74/1000 patient-months. No major difficulties were found in the management of anticoagulant treatment and its association with antiplatelet drugs in children.