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Anticoagulation in Pediatric Patients
Marilyn J Manco-Johnson1, Aparna Annam2, Timothy Schardt3
1Department of Pediatrics, Hemophilia & Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO.
Insights
Pediatric antithrombotic agents, including anticoagulants and antiplatelet drugs, are increasingly used. This review details their mechanisms, safety, and dosing for children.
Area of Science:
- Pediatric Pharmacology
- Hematology
- Cardiovascular Medicine
Background:
- Antithrombotic agent use is rising in pediatric populations.
- Increased inclusion in clinical trials yields more safety and efficacy data for children.
- Agents include anticoagulants (indirect, direct thrombin/Factor Xa inhibitors) and antiplatelet therapies.
Purpose of the Study:
- To review antithrombotic agents used in pediatric patients.
- To detail mechanisms of action, administration, clearance, and half-life.
- To discuss anticoagulation in thrombolytic therapy.
Main Methods:
- Literature review of antithrombotic agents in current pediatric use.
- Analysis of drug classes, mechanisms, pharmacokinetics, and safety profiles.
- Discussion of clinical indications and dosing considerations.
Main Results:
- Diverse antithrombotic classes exist with unique properties.
- Efficacy and duration depend on indication and patient stability.
- Pharmacokinetic variability necessitates careful dosing in children.
Conclusions:
- Understanding agent-specific properties is crucial for safe and effective pediatric use.
- Individualized treatment approaches are essential for optimal outcomes.
- Further research may refine antithrombotic strategies in children.
Abstract:
The use of antithrombotic agents is increasing in infants, children and adolescents. The more recent routine inclusion of children in FDA-monitored clinical trials has propelled the rapid accumulation of safety and efficacy data on these agents in pediatric patients. Antithrombotic agents in current use include indirect or antithrombin-dependent anticoagulants, intravenous direct thrombin inhibitors, direct oral anticoagulants (DOACs) targeting thrombin or factor Xa, antiplatelet agents and thrombolytic therapies. Each class of antithrombotic agent has distinct mechanisms of action, clearance routes, half-lives, safety and dosing. Anticoagulant efficacy is dependent upon the specific clinical indication and stability of the pediatric patient. Duration of anticoagulant course is also dependent upon the clinical indication as well as rate of thrombus resolution. This manuscript reviews the mechanism of action, route of administration, route of clearance and plasma half-life for the antithrombotic agents in current use in children. Use of anticoagulation in the context of thrombolytic therapy is discussed.
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