Anti-platelet agents in pediatric cardiac practice

Mohanty, Sweta; Vaidyanathan, Balu

doi:10.4103/0974-2069.107236

Cited by 25 publications

(16 citation statements)

References 25 publications

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“…Since clopidogrel therapy requires activation, mainly via CYP2C19 , these children had an increased risk of experiencing a lack of therapeutic benefit. 24 , 25 Three of the 5 children were precardiac transplant patients who experienced a lack of therapeutic benefit (thrombotic events) with clopidogrel therapy. The therapeutic regimen of all 5 patients was subsequently switched to an alternate drug (aspirin).…”

Section: Resultsmentioning

confidence: 99%

“…These data provided an opportunity to inform patients and their clinicians about the increased risks of bleeding associated with the patients’ genotypes. 24 , 25 , 26 …”

Section: Resultsmentioning

confidence: 99%

“… 27 , 28 Clopidogrel, a platelet aggregation inhibitor, is often used as an additive agent to prevent pretransplantation thrombotic events among children with left ventricular assistive devices, such as the Berlin Heart EXCOR (Berlin Heart Group). 25 However, 4 children experienced a thromboembolic event while receiving clopidogrel, and 3 of those children had reduced CYP2C19 activity. Warfarin, an anticoagulant, is commonly prescribed in pediatric populations, mainly for the treatment of thromboembolic disorders, as prophylaxis for heart valve replacement, after the receipt cavopulmonary shunts, and before Fontan completion surgery among patients with complex congenital heart disease.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of the Implementation of Pharmacogenomic Testing in a Pediatric Tertiary Care Setting

et al. 2021

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Key Points Question What is the clinical utility of a pharmacogenomic testing program that uses both point-of-care and preemptive approaches to assess potential responses to drugs in a pediatric tertiary care setting? Findings In this cohort study of 172 pediatric patients, pharmacogenomic testing of 6 pharmacogenes ( CYP2D6 , CYP2C9 , CYP2C19 , CYP3A5 , TPMT , and VKORC1 ) provided results that warranted deviation from standard treatment regimens in approximately 40% of patients in the point-of-care evaluation of targeted drugs and 80% of patients in the preemptive evaluation of a broader range of drugs for potential therapy. Meaning The study’s findings suggest that a pharmacogenomic program using both point-of-care targeted drug–guided testing and preemptive whole-genome sequencing–guided testing enhances the knowledge necessary for patient care decision-making, providing informed rationales for drug selection and dosing options.

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Section: Resultsmentioning

confidence: 99%

“…These data provided an opportunity to inform patients and their clinicians about the increased risks of bleeding associated with the patients’ genotypes. 24 , 25 , 26 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of the Implementation of Pharmacogenomic Testing in a Pediatric Tertiary Care Setting

et al. 2021

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“… 13 In this population, aspirin is used as an antithrombotic agent for a variety of congenital and acquired cardiac conditions. 20 Although the substance is generally contraindicated in children below 16 years of age because of its association with Reye’s syndrome, both children and neonates are sometimes treated with aspirin for the antiplatelet effect. 21 As the dose in both neonates and children is 1–5 mg/kg once daily, the treatment may necessitate proportions of tablets to be given.…”

Section: Introductionmentioning

confidence: 99%

Adjusting the dose in paediatric care: dispersing four different aspirin tablets and taking a proportion

et al. 2019

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What is already known on this subject ► Children lack age-appropriate medicines, and because of this dosage forms (eg, tablets) may be manipulated by, for instance, splitting, crushing or dispersing, before a small fraction is withdrawn to obtain a prescribed dose. ► MODRIC (Manipulation of Drugs Required in Children) has provided guidelines for manipulation of tablets, and the guideline recommends that dispersion should only be performed if there is knowledge about 'solubility', 'dispersibility' or 'any special characteristics of the formulation'. ► A previous study found that manipulation through dispersion and fraction extraction of tablets containing the slightly soluble substance aspirin did not result in correct doses 22 ; however, only one tablet formulation was investigated. What this study adds ► The variation in dose accuracy and dose precision that can be encountered when aspirin tablets are dispersed and a fraction (10% or 20% of the whole tablet) is withdrawn as a paediatric dose is illustrated for four different commercially available aspirin tablets (one conventional, one chewable and two dispersible) and three different mixing procedures. ► The dose accuracy varied markedly for the different kinds of tablets, and only fractions taken from the dispersible aspirin tablets came within 20% of the intended dose. ► Fractions taken from dispersions of the conventional and chewable tablets did not reach this level of accuracy, regardless of mixing procedure. AbsTrACT Objectives When caring for children in a hospital setting, tablets are often manipulated at the ward to obtain the right dose. One example is manipulation of tablets containing the slightly water-soluble substance aspirin, used in paediatric care as an antiplatelet agent. The evidence base, however, for choosing certain tablet formulations and manipulation methods over others for extraction of proportions is lacking. The aim of this study was to investigate the effect of tablet formulation and manipulation technique on the dose accuracy and precision attained when dispersing different commercially available aspirin tablets and extracting a small proportion suitable for children. Methods The manipulation methods investigated simulated those observed in the paediatric clinic. Four tablet formulations-one chewable, one conventional and two dispersible-were dispersed in 10 mL water in a medicine measure. On (1) passive dispersion, (2) mixing by stirring with the syringe, or (3) stirring and pumping the dispersion in and out of the syringe, respectively, proportions (1 mL or 2 mL) were extracted and the doses recovered were determined using a validated UHPLC (ultra high-pressure liquid chromatography) method. results Fractions from the four different dispersed aspirin tablet formulations varied from 99% to 3% of that intended with the lowest degree of mixing, and from 96% to 34% of that intended with the highest degree of mixing. Only the dispersible tablets gave average doses within 20% of the intended dose. Conclusions Fraction extraction from d...

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“… 12 Aspirin continues to be a widely used antiplatelet agent in pediatric cardiac practice, including intracardiac device or stent implantation. 18 The use of aspirin monotherapy for 6 months following pulmonary artery stenting has been reported in humans 19 , 20 and was selected in our case. We advise waiting ≥6 months before discontinuation of antiplatelet therapy to ensure endothelialization of the stent.…”

Section: Discussionmentioning

confidence: 99%

Transpulmonary Stent Implantation for Dysplastic Pulmonary Valve Stenosis with a Single Left Coronary Ostium and Anomalous Prepulmonary Right Coronary Artery in an English Bulldog

Markovic

Whipp²,

Morgan

et al. 2020

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Anti-platelet agents in pediatric cardiac practice

Cited by 25 publications

References 25 publications

Assessment of the Implementation of Pharmacogenomic Testing in a Pediatric Tertiary Care Setting

Assessment of the Implementation of Pharmacogenomic Testing in a Pediatric Tertiary Care Setting

Adjusting the dose in paediatric care: dispersing four different aspirin tablets and taking a proportion

Transpulmonary Stent Implantation for Dysplastic Pulmonary Valve Stenosis with a Single Left Coronary Ostium and Anomalous Prepulmonary Right Coronary Artery in an English Bulldog

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