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Heparin therapy in pediatric patients
A H Sutor1, P Massicotte, M Leaker
1Hamilton Civic Hospitals Research Centre, Ontario, Canada.
Insights
Heparin is vital in pediatric care, but adult protocols may not be optimal for children due to age-related differences in hemostasis. Further pediatric-specific trials are needed to refine heparin use in children.
Area of Science:
- Pediatric Pharmacology
- Hematology
- Critical Care Medicine
Background:
- Heparin is frequently used in pediatric tertiary care for various life-support and treatment applications.
- Current pediatric heparin protocols are adapted from adult guidelines, potentially overlooking age-specific physiological differences.
Purpose of the Study:
- To review the impact of age on heparin's anticoagulant activity and pharmacokinetics in pediatric patients.
- To discuss current and future applications of heparin and low-molecular-weight heparins in pediatric medicine.
Main Methods:
- Literature review summarizing age-related influences on heparin.
- Discussion of pediatric indications, monitoring, dosing, and side effects of heparin therapy.
- Summary of low-molecular-weight heparin use in pediatric populations.
Main Results:
- Age-dependent physiological and pathological variations in pediatric hemostasis affect heparin's activity.
- Significant differences exist between adult and pediatric responses to heparin therapy.
- Low-molecular-weight heparins present potential future options for pediatric anticoagulation.
Conclusions:
- Optimal heparin use in pediatric patients requires consideration of age-specific hemostatic differences.
- Further multi-center international clinical trials are essential to establish evidence-based pediatric heparin guidelines.
- Until then, adult recommendations serve as interim guidance for pediatric heparin administration.
Abstract:
Advances in tertiary care pediatrics have resulted in heparin being one of the most frequently prescribed drugs in children's hospitals. Heparin is essential for cardiopulmonary bypass, extracorporeal membrane oxygenation, renal dialyses, maintenance of patency of venous and arterial catheters, and treatment of thromboembolic events. Currently, protocols validated in adults are used for children. However, optimal use of heparin in pediatric patients will likely differ from adults because of age-dependent physiologic and pathologic differences in hemostasis that influence the activities of heparin. The following review summarizes the influence of age on heparin anticoagulant activities, and pharmacokinetics. The indications, monitoring, therapeutic range, factors influencing dose-response relationships, and side effects of heparin therapy in pediatric patients are discussed. Finally the current and future indications for low-molecular-weight heparins in pediatric patients are summarized. Multi-centered, international clinical trials are urgently needed to assess and optimize the use of heparin in pediatric patients in a variety of clinical settings. Until these studies are completed, recommendations for adults provide guidelines for children.