Antiplatelet Therapy Monitoring in Neonates and Children

Abstract

Antiplatelet agents are used for the prevention and treatment of thromboembolic disease in an increasingly complex population of pediatric patients. Despite their importance for clinical outcome, there is no consensus on the most effective monitoring strategies. This review describes the current state of knowledge focusing on antiplatelet therapy monitoring in children. The authors searched five databases (PubMed-NCBI, MEDLINE-OVID, SCOPUS-Elsevier, ScienceDirect, and Cochrane) from January 2000 to October 2017 using keywords selected a priori. Identified articles were sorted according to the antiplatelet agents administered, methods of antiplatelet monitoring, and outcome measures. Twenty studies were included, with 14 cohort studies, 3 randomized controlled trials, and 3 cross-sectional studies. Eleven different antiplatelet monitoring tools were used, with the most common being Light Transmission Aggregometry, Urinary Thromboxane, Thromboelastography with Platelet Mapping, and VerifyNow. In the majority of studies, antiplatelet therapy monitoring was used to describe adequacy or responsiveness to treatment based on laboratory cut-off values, which were not uniform and sourced from adult studies or extrapolated from test manuals. Several studies evaluated monitoring related to clinical outcome or adjusted therapy to reach predefined therapeutic targets. There was no single laboratory method found to be distinctly better for monitoring antiplatelet treatment. Associations between laboratory assays and clinical outcomes or assays and gold standard measurements were highly inconsistent. The current literature lacks consensus on clinical benefits and measurable effects of monitoring antiplatelet therapy in pediatric patients. This review highlights important areas for research required to determine the value of antiplatelet therapy monitoring in children.

CYP2C19 polymorphisms and lipoproteins associated with clopidogrel resistance in children with Kawasaki disease in China: A prospective study

“…On the other hand, clinical factors such as clopidogrel dosage, drug interaction (e.g., statins), platelet function, liver metabolic function, and renal dysfunction can also affect the antiplatelet effect of clopidogrel ( 10 , 13 , 18 – 20 ). In pediatric population, the clinical application of clopidogrel is limited, and it is mainly used for pediatric cardiac conditions, such as congenital heart disease, intracardiac stents or devices, and KD ( 21 , 22 ). Likewise, published information about the efficacy and safety of clopidogrel in pediatric diseases such as KD is very insufficient, and the currently available literatures are mainly case series reports and small retrospective studies, lacking evidence-based medical data from prospective multicenter randomized controlled trials ( 21 , 22 ).…”

“…In pediatric population, the clinical application of clopidogrel is limited, and it is mainly used for pediatric cardiac conditions, such as congenital heart disease, intracardiac stents or devices, and KD ( 21 , 22 ). Likewise, published information about the efficacy and safety of clopidogrel in pediatric diseases such as KD is very insufficient, and the currently available literatures are mainly case series reports and small retrospective studies, lacking evidence-based medical data from prospective multicenter randomized controlled trials ( 21 , 22 ). Besides, children’s physiological characteristics and disease states are different from adults’, so it remains uncertain whether the findings in adults are applicable to children.…”

Editorial Compilation VI

“…Accordingly, the aim of the present review is to summarize the history, key works, and present understanding of the syndrome and outline present-day diagnostic and clinical problems and controversies. 23 This issue of STH then moves from potential pregnancyrelated complications, to monitoring antiplatelet therapy in neonates and children, within a systematic review from Huang et al 25 As well recognized by our readership, antiplatelet agents are used for prevention and treatment of thromboembolic disease. This review, therefore, focuses on the increasingly complex population of pediatric patients.…”