Anticoagulation in children: making the most of little patients and little evidence
Pediatric review published in Blood Cells, Molecules & Diseases (2017)
Abstract
Thrombotic complications are increasing at a steady and significant rate in children resulting in the more widespread use of anticoagulation in this population. Anticoagulant drugs in children can be divided into the standard agents (heparin, low molecular weight heparin, and vitamin K antagonists) and alternative agents (argatroban, bivalirudin, and fondaparinux). This review will compare and contrast the standard and alternative anticoagulants and suggest situations in which it may be appropriate to use argatroban, bivalirudin, and fondaparinux. Clearly, the standard anticoagulants all have significant shortcomings including variable pharmacokinetics, issues with therapeutic drug monitoring, frequency of administration, efficacy, and adverse effects. The alternative anticoagulants have properties which overcome these shortcomings and prospective clinical trial data are presented supporting the current and future use of these agents in place of the standard anticoagulants.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Pediatric anticoagulation review covering heparin, LMWH, warfarin, DOACs, and direct thrombin inhibitors including bivalirudin and lepirudin in pediatric thrombosis and HIT.
Why This Matters for Hirudotherapy
This review compares and contrasts standard pediatric anticoagulants (heparin, low molecular weight heparin, vitamin K antagonists) with alternative agents including argatroban, bivalirudin, and fondaparinux, suggesting clinical scenarios where alternatives may be preferable given the standard agents' shortcomings in variable pharmacokinetics, drug monitoring, administration frequency, efficacy, and adverse effects. The authors present prospective clinical trial data supporting current and future use of these alternative anticoagulants in place of standard agents. For ASH's domain, this review has no defensible connection to hirudotherapy or the leech secretome—the abstract lists bivalirudin as an alternative anticoagulant without any mention of leeches, hirudin, or drug derivation from leech-derived compounds.
Citation
Anticoagulation in children: making the most of little patients and little evidence.
Young G · Blood cells, molecules & diseases, 2017
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