Anticoagulants in children with renal impairment: a narrative review
Review published in Seminars in Thrombosis and Hemostasis (2025)
Abstract
Venous thromboembolism is a common cause of morbidity and mortality in children with renal disease. To properly treat and prevent thromboembolism in this patient population, it is important to be familiar with the multitude of anticoagulant agents currently available. Many anticoagulant drugs undergo some extent of renal elimination. There are important considerations for the selection, dosing, and monitoring of anticoagulant drugs for patients with renal impairment due to various pharmacokinetic alterations that may occur. While there are data to help guide dosing and monitoring in adults, evidence regarding renal dose adjustment of many anticoagulant drugs in children are limited. For the clinician, anticoagulation management in children with renal impairment presents unique challenges. In addition to considering overall bleeding risk, the extent of renal impairment may vary by patient, making a one-size-fits-all approach to managing these patients difficult. These factors, combined with limited data, can make managing anticoagulation in children with renal impairment a challenge. Therefore, the focus of this review will be to describe the pharmacokinetics of the following anticoagulants in children with impaired renal function: unfractionated heparin, enoxaparin, dalteparin, rivaroxaban, apixaban, edoxaban, fondaparinux, bivalirudin, argatroban, dabigatran, and warfarin.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Pediatric review covering anticoagulant dosing in renal impairment including bivalirudin, argatroban and direct thrombin inhibitor adjustments by GFR.
Why This Matters for Hirudotherapy
This review article describes the pharmacokinetics of multiple anticoagulant agents—including unfractionated heparin, enoxaparin, dalteparin, rivaroxaban, apixaban, edoxaban, fondaparinux, bivalirudin, argatroban, dabigatran, and warfarin—in children with renal impairment, addressing the challenges of dosing and monitoring in this population. The authors note that evidence regarding renal dose adjustment of many anticoagulant drugs in children is limited. The abstract does not mention leeches, hirudin derivation, or hirudotherapy, so no defensible connection to ASH's domain can be established from this article alone. The review provides broad pharmacological context but is not focused on any leech-related compound or therapy.
Citation
Anticoagulants in children with renal impairment: a narrative review.
Kiskaddon AL et al. · Seminars in thrombosis and hemostasis, 2025
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