Anticoagulation Therapy in Children.
Review published in Seminars in thrombosis and hemostasis (2017)
Abstract
Venous thromboembolism (VTE) is very uncommon in children and adolescents compared with older adults, though its incidence has significantly increased over the past two decades. Given the rarity of the condition, the data on pediatric VTE lag behind the adult experience and consequently the management of VTE in children is, in large part, modeled on the adult strategies. This approach has certain limitations, given that young children have developmental particularities of the hemostatic system and differences in the pharmacokinetics and pharmacodynamics of various anticoagulant agents. The most commonly used anticoagulants in children continue to be the heparins and the vitamin K antagonists. Direct intravenous thrombin inhibitors, argatroban, bivalirudin, have very limited pediatric use. The non-vitamin K antagonist oral anticoagulant drugs (novel oral anticoagulants) present potential advantages in terms of efficacy, safety, and convenience, though pediatric data are limited to preclinical and small phase I trials. There are several ongoing phase I, II, and III trials for dabigatran rivaroxaban, apixaban, and edoxaban, the results of which are likely to change the future management of pediatric thromboses.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Venous thromboembolism (VTE) is very uncommon in children and adolescents compared with older adults, though its incidence has significantly increased over the past two decades. Given the rarity of the condition, the data on pediatric VTE lag behind the adult experience and consequently the...
Why This Matters for Hirudotherapy
This review addresses the management of venous thromboembolism (VTE) in children and adolescents, noting that treatment strategies are largely extrapolated from adult data despite distinct developmental hemostatic differences. It discusses the limited pediatric use of direct intravenous thrombin inhibitors like argatroban and bivalirudin, alongside emerging trials for novel oral anticoagulants. The relevance of this article to ASH lies in its discussion of bivalirudin, a synthetic analog of hirudin derived from leech saliva. Reviewing the clinical application and limitations of hirudin-like compounds in pediatric populations highlights the ongoing pharmacological significance of leech-derived mechanisms. However, the study does not discuss leeches or actual hirudotherapy, serving only as broad, indirect background on anticoagulant therapies related to the leech secretome.
Citation
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026