Efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome.
BACKGROUND
Hemolytic uremic syndrome is a thrombotic microangiopathy. Clopidogrel, a recently developed platelet aggregation inhibitor, has not been previously reported as a treatment for this illness. Our study's objective was to explore the efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome.


METHODS
We performed a retrospective chart review of all children (≤ 18 years) hospitalized with diarrhea associated hemolytic uremic syndrome. Outcomes in clopidogrel treated children were described. In subgroup analysis, outcomes were compared to those untreated with platelet aggregation inhibitors.


RESULTS
Of 72 children with diarrhea associated hemolytic uremic syndrome, 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%). The median age of clopidogrel treated children was 5 years; 40% were male. Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53 × 10(3)/μL, and 2.3mg/dL respectively. Clopidogrel (median dose 1mg/kg/d) was given for a median of 4 days (range 1-15). Other therapies included erythropoietin (98%), red blood cell transfusions (80%), diuretics (58%), anti-hypertensive agents (45%), and dialysis (33%). The median hospital length of stay was 9 days (range 3-26). Three children had bleeding complications (epistaxis/hematemesis). The risk of chronic kidney disease was 5% and death 2.5%. In subgroup analysis, median duration of dialysis was 11 days in thirteen clopidogrel treated children compared to 21 days in five untreated patients (P=0.04).


CONCLUSIONS
Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.
Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USA. leonard.seltz@childrenscolorado.org
L Barry
LB
Seltz
Leigh Anne
LA
Bakel
Jennifer
J
Tiehen
Dexiang
D
Gao
Melissa A
MA
Cadnapaphornchai
Gary
G
Lum
Douglas
D
Ford
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000077144:Clopidogrel; D003967:Diarrhea / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine