Tendencias en el uso de inhibidores directos de la trombina por vía parenteral en pacientes pediátricos: análisis de una gran base de datos administrativa

CONTEXT: Parenteral direct thrombin inhibitors (DTIs) may be used in pediatric patients with contraindications to heparin therapy, such as heparin-induced thrombocytopenia. Few data exist regarding the use of DTIs in pediatric patients. OBJECTIVE: To characterize the use of DTIs in pediatric patients, including monitoring strategies and bleeding complications. DESIGN: A retrospective descriptive study was designed and the Pediatric Health Information System database was queried from 2004 to 2011 for pediatric patients receiving a parenteral DTI. Patient demographic and hospital data, mortality, disease state, and procedure information (from International Classification of Diseases, Ninth Revision codes) were collected from the query. DTI monitoring information was also collected. Patients were divided into 2 time periods (2004-2007, 2008-2011) to evaluate trends. RESULTS: Two hundred eight patients met study criteria (50.9% male, 64.4% white), and children (2-12 years of age) represented 34.6% of the population. Congenital heart disease was present in 43.8% and cardiovascular surgical procedure occurred in 28.4%. Argatroban was most commonly used (73.1%) and bivalirudin use increased (P < .001). Bleeding complications were present in 37.9% of patients and mortality was 19.7%. Bleeding complications were associated with lepirudin (62.5%) and argatroban (41.7%) more often as compared with bivalirudin (18.8%) (P < .001). Activated partial thromboplastin time and prothrombin time were used more often in patients receiving argatroban and lepirudin in comparison with bivalirudin, and thrombin time was used more often in patients receiving lepirudin (P < .001). Activated clotting time use increased over time (5.1% versus 17.5%, P = .02). CONCLUSION: Pediatric use of DTIs is infrequent and occurs in patients with high morbidity and mortality.

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.

En la base de datos Pediatric Health Information System (2004–2011) se identificaron 208 pacientes pediátricos tratados con inhibidores directos parenterales de la trombina. Predominó el argatrobán (73,1 %) y aumentó el uso de bivalirudina (p < 0,001). Hubo mortalidad del 19,7 % y complicaciones hemorrágicas en el 37,9 %, más frecuentes con lepirudina (62,5 %) y argatrobán (41,7 %) que con bivalirudina (18,8 %; p < 0,001). Según los autores, su uso pediátrico es infrecuente, en pacientes con alta morbimortalidad.

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