Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database
Research article published in Archives of pathology & laboratory medicine (2014)
Abstract
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database.
Почему это важно для гирудотерапии
Данное ретроспективное описательное исследование с использованием запросов к крупной административной базе данных (Pediatric Health Information System, 2004–2011 гг.) было направлено на характеристику применения, стратегий мониторинга и геморрагических осложнений парентеральных прямых ингибиторов тромбина у 208 пациентов детского возраста. Аргатробан применялся наиболее часто (73,1%), использование бивалирудина со временем увеличилось, а применение лепирудина ассоциировалось с частотой геморрагических осложнений 62,5%. В реферате нет упоминаний пиявок, гирудина или гирудотерапии, поэтому релевантность для области интересов ASH данной статьей не подтверждается. В исследуемой популяции отмечалась высокая общая заболеваемость и смертность, а в реферате не обсуждается какая-либо связь с пиявками или прикладной контекст гирудотерапии.
Цитирование
Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database
Moffett BS et al. · Archives of pathology & laboratory medicine, 2014
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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