Management of thrombosis in children and neonates: practical use of anticoagulants in children

Abstract

Venous thrombosis (VTE) in children and neonates presents numerous management challenges. Although increasing in frequency, VTE in children and neonates is still uncommon compared with adults. The epidemiology of VTE is vastly different in neonates vs children vs adolescents vs adults. In reality, pediatric thrombosis should be viewed as a multitude of rare diseases (eg, renal vein thrombosis, spontaneous thrombosis, catheter-related thrombosis, cerebral sinovenous thrombosis), all requiring different approaches to diagnosis and with different short- and long-term consequences, but linked by the use of common therapeutic agents. Further, children have fundamentally different physiology in terms of blood flow, developmental hemostasis, and, likely, endothelial function. The American Society ofHematology 2017 Guidelines for Management of Venous Thromboembolism: Treatment of Pediatric VTE provides up-to-date evidence-based guidelines related to treatment. Therefore, this article will focus on the practical use of therapeutic agents in the management of pediatric VTE, especially unfractionated heparin, low-molecular-weight heparin, and oral vitamin K antagonists, as the most common anticoagulants used in children. Direct oral anticoagulants (DOACs) remain in clinical trials in children and should not be used outside of formal trials for the foreseeable future.

COVID-19 Associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate

“…Nonetheless, in case of symptomatic 'documented' thrombotic event or acro-ischemia, UFH is the ideal agent to use in pediatric intensive care setting, especially for those with renal insufficiency. For reasons unknown, heparin-induced thrombocytopenia seems to occur rarely in children [35].…”

Direct oral anticoagulants for unusual‐site venous thromboembolism

“…Renal vein thrombosis (RVT) is around 30 times less frequent than lower limb DVT 90 but is the most frequent non–catheter‐related thrombosis in neonates 91,92 . The most common risk factor for RVT is nephrotic syndrome, especially membranous glomerulonephritis 93 .…”

“…Renal vein thrombosis (RVT) is around 30 times less frequent than lower limb DVT 90 but is the most frequent non-catheter-related thrombosis in neonates. 91,92 The most common risk factor for RVT is nephrotic syndrome, especially membranous glomerulonephritis. 93 Other risk factors include malignancies (particularly renal cell carcinoma), surgery (including urological procedures and kidney transplantation), and abdominal trauma or infections.…”

Venous Thromboembolism in Children: From Diagnosis to Management

“…Maintenance UFH doses are age dependent: infants need the highest doses (on average 28 U/kg per hour) and children need slightly lower doses (on average 20 U/kg per hour). The doses of UFH required for older children are similar to the weight-adjusted requirements in adults (18 U/kg per hour) [ 1 ]. LMWH is the first-choice drug in paediatric VTE because it can be administered subcutaneously and it requires no monitoring of Prothrombin time (PT) and aPTT [ 39 , 62 , 63 ].…”

“…Venous thromboembolism (VTE) in children is a severe issue with high mortality rates and can cause acute and chronic related complications, such as pulmonary embolism, cerebro-vascular events, and post-thrombotic syndrome (PTS) [ 1 , 2 ]. In recent years, the occurrence of VTE in the pediatric population has increased, due to both greater exposure to risk factors, and improved diagnostic techniques [ 3 , 4 ].…”