|Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.|
|PMID: 22315277 Owner: NLM Status: MEDLINE|
|BACKGROUND: Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children.
METHODS: The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
RESULTS: We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C).
CONCLUSIONS: The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
|Paul Monagle; Anthony K C Chan; Neil A Goldenberg; Rebecca N Ichord; Janna M Journeycake; Ulrike Nowak-Göttl; Sara K Vesely;|
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|Type: Journal Article; Practice Guideline|
|Title: Chest Volume: 141 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Feb|
|Created Date: 2012-02-08 Completed Date: 2012-04-13 Revised Date: 2013-04-08|
Medline Journal Info:
|Nlm Unique ID: 0231335 Medline TA: Chest Country: United States|
|Languages: eng Pagination: e737S-801S Citation Subset: AIM; IM|
|Haematology Department, The Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia.|
|APA/MLA Format Download EndNote Download BibTex|
administration & dosage,
Blood Coagulation Tests
Dose-Response Relationship, Drug
Drug Administration Schedule
Factor Xa / antagonists & inhibitors
Fibrinolytic Agents / administration & dosage*, adverse effects
Hemorrhage / blood, chemically induced, prevention & control
Heparin / administration & dosage, adverse effects
Heparin, Low-Molecular-Weight / administration & dosage, adverse effects
Platelet Aggregation Inhibitors / administration & dosage, adverse effects
Recurrence / prevention & control
Thrombosis / blood, drug therapy*, etiology, prevention & control*
Upper Extremity Deep Vein Thrombosis / blood, drug therapy, prevention & control
Vitamin K / antagonists & inhibitors
|0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Platelet Aggregation Inhibitors; 12001-79-5/Vitamin K; 9005-49-6/Heparin; EC 22.214.171.124/Factor Xa|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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