Heparin-induced thrombocytopenia in the pediatric intensive care unit population

Frost, Jason; Mureebe, Leila; Russo, Pierantonio; Russo, Joanne; Tobias, Joseph D.

doi:10.1097/01.pcc.0000154947.46400.17

Cited by 17 publications

(10 citation statements)

References 41 publications

(33 reference statements)

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“…This may be the same for the neonatal population. 13,[18][19][20] However, based on current treatment guidelines, 7 it is difficult to obtain therapeutic ranges of enoxaparin in neonates compared with other pediatric patients. 17 Because of a lack of pediatric formulations for enoxaparin, accurate dosing is more difficult due to the small administered volumes.…”

mentioning

confidence: 99%

Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

et al. 2007

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Enoxaparin may be effective in the treatment of neonatal thrombosis. An initial dosage of 1.5 mg/kg every 12 hours is likely inadequate to obtain therapeutic antifactor Xa levels rapidly and differs for term and preterm neonates. Therapeutic levels in preterm infants may be more variable, and the pharmacokinetics of this drug in preterm infants requires further evaluation. Future studies in neonates should prospectively evaluate a higher starting dose of enoxaparin to document effectiveness, acceptance, compliance with treatment guidelines, and adverse effects.

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mentioning

confidence: 99%

Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

et al. 2007

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“…[70][71][72] The serological assay most commonly used in children is the ELISA test. 43,48,68,69,[74][75][76][77][78][79][80][81][82][83] Immunoassays are available at most clinical laboratories and are technically less demanding than functional assays. 6,84,85 Additional advantages include their increased sensitivity (.97%) compared to functional assays and the fact that results are unaffected by platelet or plasma factors.…”

Section: Laboratory Testsmentioning

confidence: 99%

“…In all pediatric cases identified, at least one TEC was observed prior to HIT diagnosis. 3,9,43,44,48,[68][69][70][74][75][76][77][78][79][80][81][82][83]98,99 Studies in humans suggest that the thrombotic risk is higher in patient with higher levels of PF4-heparin antibody. 100 While the thromboembolic events may be arterial or venous in origin, venous thromboses are more commonly observed and include thrombi in the subclavian and femoral veins 42,97 Pulmonary embolism, a common complication in adult patients with HIT, is rarely seen in young children (,12 years old).…”

Section: Thrombosis and Other Complicationsmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia in the Pediatric Population: A Review of Current Literature

Vakil

Kanaan

Donovan

2012

The Journal of Pediatric Pharmacology and Therapeutics

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Heparin-induced thrombocytopenia is a rare and serious reaction to unfractionated heparin and low-molecular-weight heparins in children. Quick recognition, discontinuation of heparin, and subsequent treatment with an alternative anticoagulant are essential steps to prevent serious complications such as thrombus and limb amputation. The purpose of this review is to describe the clinical features of heparin-induced thrombocytopenia in children and to summarize the data available for its management. This paper summarizes data and relates the use of direct thrombin inhibitors with clinical outcomes. A literature search was conducted with Ovid, using the key terms argatroban, bivalirudin, hirulog, danaparoid, lepirudin, direct thrombin inhibitor, heparin-induced thrombocytopenia, thrombosis, warfarin, and fondaparinux. Articles were excluded if they were classified as editorials, review articles, or conference abstracts or if they involved patients 18 years of age or older or described disease states not related to thrombosis. Nineteen articles containing 33 case reports were identified and evaluated for this review. Of the 33 cases, 14, 10, 4, and 2 cases described the use of lepirudin, danaparoid, argatroban, and bivalirudin, respectively. Two cases did not report the type of anticoagulant used, and 1 case used aspirin. The most commonly reported complication was bleeding.

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“…Clinical symptomatology typically occurs 5–10 days after heparin exposure with a ≥50% decrease in platelet count and resistance to heparin anticoagulation or unexplained thrombotic events. 8 HIT is clinically judged using the following “4 T’s” scoring system: thrombocytopenia, timing of platelet count fall, thrombosis, and other causes for thrombocytopenia. The diagnosis of HIT is also based on laboratory findings, including an enzyme-linked immunosorbent assay (ELISA) and serotonin release assay.…”

Section: Introductionmentioning

confidence: 99%

Perioperative care in an adolescent patient with heparin-induced thrombocytopenia for placement of a cardiac assist device and heart transplantation: case report and literature review

Sebastian¹,

McConnell²,

Gómez³

et al. 2017

IMCRJ

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Heparin-induced thrombocytopenia (HIT) can cause life-threatening complications following the administration of heparin. Discontinuation of all sources of heparin exposure and the use of alternative agents for anticoagulation are necessary when HIT is suspected or diagnosed. We present the successful use of bivalirudin anticoagulation in an adolescent patient during cardiopulmonary bypass who underwent both placement of a left ventricular assist device and subsequent heart transplantation within a 36-hour period. The pathophysiology and diagnosis of HIT are reviewed, previous reports of the use of direct thrombin inhibitors for cardiac surgery are presented, and potential dosing regimens for bivalirudin are discussed.

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Heparin-induced thrombocytopenia in the pediatric intensive care unit population

Abstract: Although well described in the adult literature, there have been a limited number of reports of HIT in pediatric-aged patients. Given its potential for morbidity, HIT should be considered in the differential diagnosis of thrombocytopenia in the pediatric ICU patient.

Cited by 17 publications

References 41 publications

Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

Enoxaparin Use in the Neonatal Intensive Care Unit: Experience Over 8 Years

Heparin-Induced Thrombocytopenia in the Pediatric Population: A Review of Current Literature

Perioperative care in an adolescent patient with heparin-induced thrombocytopenia for placement of a cardiac assist device and heart transplantation: case report and literature review

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