title: Antithrombotic therapy for ventricular assist devices in children: do we really know what to do?
abstract: The use of ventricular assist devices (VADs) in children is increasing. Stroke and device-related thromboembolism remain the most feared complications associated with VAD therapy in children. The presence of a VAD causes dysregulation of hemostasis due to the presence of foreign materials and sheer forces intrinsic to the device resulting in hypercoagulability and potentially life-threatening thrombosis. The use of antithrombotic therapy in adults with VADs modulates this disruption in hemostasis, decreasing the risk of thrombosis. Yet, differences in hemostasis in children (developmental hemostasis) may result in variances in dysregulation by these devices and preclude the use of adult guidelines. Consequently, pediatric device studies must include safety and efficacy estimates of device-specific antithrombotic therapy guidelines. This review will discuss mechanisms of hemostatic dysregulation as it pertains to VADs, goals of VAD antithrombotic therapy for children and adults, and emerging antithrombotic strategies for VAD use in children.
authors.affiliation: KIDCLOT Pediatric Thrombosis, Stollery Children's Hospital, Edmonton, AB, Canada.|University of Alberta, Edmonton, AB, Canada.
authors.forename: M P
authors.initials: MP
authors.lastname: Massicotte
authors.affiliation: KIDCLOT Pediatric Thrombosis, Stollery Children's Hospital, Edmonton, AB, Canada.|University of Alberta, Edmonton, AB, Canada.
authors.forename: M E
authors.initials: ME
authors.lastname: Bauman
authors.affiliation: Division of Cardiology, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.|Stanford University, Stanford, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Murray
authors.affiliation: Division of Cardiology, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.|Stanford University, Stanford, CA, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Almond
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D016276:Ventricular Function
chemical_list: D005343:Fibrinolytic Agents
keywords: drug therapy; heart failure; heart‐assist device; pediatrics; thrombosis