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 narrative review examined anticoagulant options for children, comparing standard agents (heparin, low molecular weight heparin, vitamin K antagonists) with alternative agents including argatroban, bivalirudin, and fondaparinux, and discussed clinical scenarios where the alternatives may be preferable given shortcomings of standard anticoagulants. For ASH and hirudotherapy, this review is relevant because bivalirudin is a synthetic analog of hirudin, the potent anticoagulant derived from medicinal leech saliva, illustrating how a leech-secretome compound has been translated into a clinically used pediatric anticoagulant. The abstract notes that prospective clinical trial data are presented supporting current and future use of these alternative agents. However, this is a pharmacology review focused on pharmaceutical anticoagulants in pediatric care, not on leech therapy itself; it does not address hirudotherapy or the broader leech secretome, and its discussion of bivalirudin is as a manufactured drug rather than a leech-derived intervention.
Citation
Anticoagulation in children: making the most of little patients and little evidence.
Young G · Blood cells, molecules & diseases, 2017
Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026