Inhibidores directos de la trombina intravenosos para la tromboembolia venosa aguda o la trombocitopenia inducida por heparina con trombosis en niños: una revisión sistemática de la literatura

Intravenous direct thrombin inhibitors (DTIs) are used for thromboembolic disorders. This systematic review aims to characterize intravenous DTI agents, dosing, monitoring strategies (or use), bleeding, and mortality, in pediatric patients with acute venous thromboembolism (VTE) or heparin-induced thrombocytopenia with thrombosis (HITT). MEDLINE, Embase, and Cochrane's CENTRAL were searched from inception through July 2023. Case series, retrospective studies, and prospective studies providing per-patient or summary data for patients < 18 years of age with VTE or HITT treated with an intravenous DTI were included. Selection and data extraction were conducted independently by two reviewers. Sixteen studies (7 case reports, 1 case series, 5 retrospective studies, 3 prospective studies) with 85 patients were included. Target conditions included acute VTE in 54 (64%) and HITT in 31 (36%) patients. Bivalirudin, argatroban, and lepirudin were used in 52 (61%), 27 (32%), and 6 (7%) patients, respectively. Fifty-two (61%) patients received a bolus dose, and weighted mean infusion rates for bivalirudin, argatroban, and lepirudin were 0.2 mg/kg/hr, 1.2 mcg/kg/min, and 0.15 mg/kg/hr, respectively. The activated partial thromboplastin time was utilized for monitoring in 82 (96%) patients. Complete or partial thrombus resolution was reported in 53 (62%) patients, mortality in 6 (7%) patients, and bleeding complications in 14 (16%) patients. In this systematic review involving 85 pediatric patients treated with an intravenous DTI for acute VTE or HITT, bivalirudin was the most commonly utilized agent, with a rate of resolution over 60% despite a high acuity in the population studied. Prospective collaborative studies are warranted to establish optimal dosing and further characterize VTE and bleeding outcomes.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Se analizaron 16 estudios con 85 pacientes pediátricos: 54 (64 %) con tromboembolia venosa aguda y 31 (36 %) con TIH y trombosis. Bivalirudina, argatrobán y lepirudina se usaron en 52 (61 %), 27 (32 %) y 6 (7 %); 82 (96 %) se monitorizaron con TTPa. Hubo resolución completa o parcial del trombo en 53 (62 %), hemorragias en 14 (16 %) y muerte en 6 (7 %). La bivalirudina fue la más usada; los autores piden estudios prospectivos.

Explore cómo esta investigación se conecta con la práctica clínica

Más estudios revisados por pares en la categoría «Desarrollo de fármacos».

• Hirudoterapia en medicina y odontología — Jha K et al. (2015)
• Terapia con sanguijuelas: una historia — Hyson J (2005)
• Hirudinas de la sanguijuela medicinal asiática Hirudinaria manillensis: iguales, pero diferentes — Lukas P et al. (2019)
• Transcriptomic analysis of the salivary gland of medicinal leech Hirudo nipponia — Lu Z et al. (2018)
• Molecular dynamic and pharmacological studies on protein-engineered hirudin variants of Hirudinaria manillensis and Hirudo medicinalis — Sun Y et al. (2022)
• Síntesis acelular de la variante 1 de hirudina de la sanguijuela hematófaga Hirudo medicinalis — Wüstenhagen D et al. (2020)
• Producción de variantes de hirudina mediante fábricas microbianas modificadas genéticamente — Zhang J, Lan N (2018)
• Hirudina en la trombocitopenia inducida por heparina — Lubenow N, Greinacher A (2002)
• La hirudina mejora la nefropatía diabética al inhibir la piroptosis mediada por Gsdmd — Han J et al. (2023)
• La hirudina como anticoagulante alternativo: una revisión histórica — Markwardt F (2002)

Ver toda la investigación analizada por la ASH →