Anticoagulants in Children with Renal Impairment: A Narrative Review
Narrative 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.
Resumen
Comprehensive narrative review on pharmacokinetics of anticoagulants (including bivalirudin, argatroban) in pediatric renal impairment, where data are limited but renal elimination drives dosing decisions.
Por qué esto importa para la hirudoterapia
Esta revisión describe la farmacocinética, selección, dosificación y monitorización de diversos anticoagulantes en niños con insuficiencia renal, enumerando agentes como heparina no fraccionada, enoxaparina, dalteparina, rivaroxabán, apixabán, edoxabán, fondaparinux, bivalirudina, argatrobán, dabigatrán y warfarina. Destaca que muchos anticoagulantes experimentan eliminación renal y que los datos pediátricos para el ajuste posológico renal son limitados. El resumen no caracteriza la bivalirudina como derivada de sanguijuela, como inhibidor directo de la trombina ni como derivado de la hirudina, limitándose a enumerarla por su nombre entre muchos otros agentes. La revisión evalúa anticoagulantes farmacéuticos y no menciona la hirudoterapia, extractos de saliva de sanguijuela ni la aplicación real de sanguijuelas, por lo que su relevancia para ASH es, en el mejor de los casos, indirecta.
Citación
Anticoagulants in Children with Renal Impairment: A Narrative Review.
Kiskaddon AL et al. · Seminars in Thrombosis and Hemostasis, 2025
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026