Unfractionated heparin therapy in infants and children.
Unfractionated heparin is frequently used in tertiary pediatric centers for the prophylaxis and treatment of thromboembolic disease. Recent evidence suggests that the clinical outcomes of unfractionated heparin therapy in children are poor, as determined by target-range achievement and adverse-event rates. These reports of poor outcomes may be related to an age-dependent mechanism of action of unfractionated heparin. Furthermore, several published studies have indicated that unfractionated heparin-monitoring assays currently in clinical use have significant limitations that likely affect the safety and efficacy of anticoagulant management. This review summarizes the growing body of evidence suggesting that pediatric-specific recommendations for unfractionated heparin therapy management are required to improve clinical outcomes related to this commonly prescribed medication.
Newall
Fiona
F
MN, BSci, Royal Children's Hospital, Clinical Haematology Department, 9th Floor, Main Building, Flemington Road, Parkville, Victoria 3052, Australia. fiona.newall@rch.org.au
Johnston
Linda
L
Ignjatovic
Vera
V
Monagle
Paul
P
D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008134:Long-Term Care; D010024:Osteoporosis / Q000097:blood / Q000139:chemically induced; D010314:Partial Thromboplastin Time; D016032:Randomized Controlled Trials as Topic; D013918:Thrombin Time; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin