Document Detail


Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
MedLine Citation:
PMID:  22315277     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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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Publication Detail:
Type:  Journal Article; Practice Guideline    
Journal Detail:
Title:  Chest     Volume:  141     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-08     Completed Date:  2012-04-13     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e737S-801S     Citation Subset:  AIM; IM    
Affiliation:
Haematology Department, The Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / administration & dosage,  adverse effects
Blood Coagulation Tests
Cardiac Catheterization
Child
Child, Preschool
Cooperative Behavior
Dose-Response Relationship, Drug
Drug Administration Schedule
Evidence-Based Medicine*
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
Humans
Infant, Newborn
Interdisciplinary Communication
Platelet Aggregation Inhibitors / administration & dosage,  adverse effects
Recurrence / prevention & control
Renal Veins
Risk Factors
Societies, Medical*
Thrombosis / blood,  drug therapy*,  etiology,  prevention & control*
Upper Extremity Deep Vein Thrombosis / blood,  drug therapy,  prevention & control
Vitamin K / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Platelet Aggregation Inhibitors; 12001-79-5/Vitamin K; 9005-49-6/Heparin; EC 3.4.21.6/Factor Xa
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