title: Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Pediatric use of DTIs is infrequent and occurs in patients with high morbidity and mortality.
authors.affiliation: From the Department of Pharmacy, Texas Children's Hospital, and the Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston (Dr Moffett); and the Department of Pathology & Immunology, Pediatrics, and Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston (Dr Teruya).
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Jun
authors.initials: J
authors.lastname: Teruya
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000453:epidemiology; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D008297:Male; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban; C074619:bivalirudin; C083544:lepirudin