Bivalirudin for anticoagulation in children.
BACKGROUND
Thromboembolism in children is typically treated with unfractionated heparin (UH) or low molecular weight heparin (LMWH). Both rely on antithrombin (AT) for their action. In addition, heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin use in children. Bivalirudin or other direct thrombin inhibitors may be a useful alternative to heparins in treating thrombosis in children.


METHODS
We report a retrospective review to assess the efficacy and safety of bivalirudin in pediatric patients with thrombosis.


RESULTS
Sixteen children received bivalirudin for thrombosis or prevention of thrombosis at the Children's Hospital of Illinois from January 2005 to January 2007. Patients received a bolus dose of 0.25 mg/kg followed by a continuous infusion (0.16 +/- 0.07 mg kg(-1) hr(-1)) titrated to 1.5-2.5 times the baseline activated partial thromboplastin time (aPTT). Positive correlation between the bivalirudin average infusion rate and aPTT was observed in twelve patients. Ultrasonographic evidence of thrombus regression was noted at 72 hr in 10 of 10 patients. One patient experienced hematuria after catheterization of the urethra.


CONCLUSIONS
Bivalirudin was effective and well-tolerated in these patients. Further studies should be conducted to better define safety and efficacy of bivalirudin in pediatric patients.
Rayapudi
Sobharani
S
University of Illinois College of Medicine, Peoria, Illinois 61614, USA.
Torres
Adalberto
A
Deshpande
Girish G
GG
Ross
Mitchell P
MP
Wohrley
Julie D
JD
Young
Guy
G
Tarantino
Michael D
MD
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin