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Anticoagulation with warfarin in infants and children
1Children's Medical Center, University of Virginia, Charlottesville 22908, USA.
The Annals of Pharmacotherapy
|November 1, 1996
Summary
Warfarin is used in children for preventing blood clots, with initial doses of 0.1 mg/kg/d and a target INR of 1.5-3. Guidelines for pediatric warfarin use were developed from existing literature.
Area of Science:
- Pediatric Pharmacology
- Hematology
- Cardiology
Background:
- Warfarin is an anticoagulant medication with established use in adults.
- Its application in pediatric populations is less common, necessitating specific guidelines.
Purpose of the Study:
- To review the use of warfarin in infants and children.
- To establish recommendations for pediatric warfarin dosage and monitoring.
Main Methods:
- A comprehensive literature search of MEDLINE (1966-1995) was conducted.
- Articles focusing on warfarin use in individuals under 18 years were evaluated.
- Relevant adult pharmacokinetic, pharmacodynamic, and drug interaction data were also included.
Main Results:
- Warfarin is utilized for prophylaxis in pediatric prosthetic cardiac valves, autoimmune disorders, and deficiencies in protein C or S.
- It is also used to prevent embolization in pediatric deep-vein thrombosis and central venous catheter clots.
- An initial dose of 0.1 mg/kg/d is suggested, with a target International Normalized Ratio (INR) of 1.5-3, though higher ranges may be needed for specific conditions.
Conclusions:
- Limited data exists on pediatric warfarin use due to its infrequent application.
- Guidelines for initiating and monitoring warfarin in children were formulated based on available clinical trials, case reports, and practice surveys.