[Acenocoumarol (Sintrom) and fluinidione (Previscan) in pediatrics after cardiac surgical procedures].
METHODS
Between 1997 and 2001, 150 children (one month to 16 years of age) were treated with oral anticoagulants after cardiac surgery (Fontan's operations and congenital heart diseases without valvulopathy: 62%, valvular prosthesis: 20%, arrhythmia: 4.6%, thrombosis: 4%, other: 9.4%). They were first treated by either unfractionated heparin (49%) or nadroparin (51%), then by acenocoumarol (n1 = 114) or fluindione (n2 = 36) until steady state.


RESULTS
The retrospective analysis of data (age, body weight, international normalized ratio, loading and maintenance doses, time to achieve the steady state) led to the building of a dosage nomogram usable in pediatrics.


CONCLUSIONS
We demonstrated that the mean maintenance dose depended on age and weight. After three years, that dose (mg/kg) was getting close to adult values; it was higher before three years of age, especially before 12 months (p < 0.01), and very variable from a child to another. The recommended loading dose should be as close as possible to the effective maintenance dose: within that cohort, about 0.14 and 0.05 (acenocoumarol) or 1.1 and 0.40 mg kg-1 day-1 (fluindione), before 12 months and after three years respectively.
Piquet
P
P
Laboratoire d'hémostase, centre chirurgical Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France. ppiquet@ccml.com
Losay
J
J
Doubine
S
S
D000074:Acenocoumarol / Q000008:administration & dosage* / Q000494:pharmacology; D000284:Administration, Oral; D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage* / Q000494:pharmacology; D013504:Cardiovascular Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010630:Phenindione / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000494:pharmacology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies
D000925:Anticoagulants; D010630:Phenindione; C017673:fluindione; D000074:Acenocoumarol