Unfractionated Heparin Therapy in Infants and Children

Abstract

Unfractionated heparin is frequently used in tertiary pediatric centers for the prophylaxis and treatment of thromboembolic disease. Recent evidence suggests that the clinical outcomes of unfractionated heparin therapy in children are poor, as determined by target-range achievement and adverse-event rates. These reports of poor outcomes may be related to an age-dependent mechanism of action of unfractionated heparin. Furthermore, several published studies have indicated that unfractionated heparin-monitoring assays currently in clinical use have significant limitations that likely affect the safety and efficacy of anticoagulant management. This review summarizes the growing body of evidence suggesting that pediatric-specific recommendations for unfractionated heparin therapy management are required to improve clinical outcomes related to this commonly prescribed medication.

Ventricular-Atrial Junction in Post Hemorrhagic Hydrocephalus: A Rare Case of Massive Catheter Atrial Thrombosis

“…In the early childhood the only available treatment is constituted by the anticoagulant [13,14] and antibiotic therapy; however, if there are associated signs of endocarditis, these therapies do not appear decisive, but are connected to a sudden surgical treatment. Our experience is in line with the data reported in the literature [15,16] and it has clearly shown the inadequacy and limitations of the currently available medical therapy [17,18] and the need for a timely surgical intervention strategy. This evidence should be correlated to the fact that the presence of the foreign body (the catheter) perpetuates an endothelial damage, a key element already known to be the first cause in the genesis of thrombotic phenomena, as described by Virchow in his famous triad.…”

Antithrombotic Therapy in Neonates and Children

“…284 This review considered two eligible randomized trials, 285 which included 267 neonates. There was reduced risk of catheter occlusion (typical risk ratio [RR], 0.28; 95% CI, 0.15-0.53; number needed to treat, 5; 95% CI, [3][4][5][6][7][8] and no difference in the duration of catheter patency; however, one study evaluated time to catheter removal, censoring patients whose catheter was removed because of therapy completion or death, and identifi ed benefi t with heparin (adjusted hazard ratio, 0.55; 95% CI, 0.36-0.83). 285 This fi nding could be due to a higher incidence of elective removal of emboli at the time of central venous access device (CVAD) removal in neonates with CVAD-related VTE, 276 many clinicians advocate delay in CVAD removal until 3 to 5 days of anticoagulant therapy have been given.…”

Antithrombin activity and heparin response in neonates and infants undergoing congenital cardiac surgery: a retrospective cohort study

“…23,24 Similarly, the pharmacodynamics of heparin are age dependent, with decreased antithrombotic effects measured by anti-Xa and anti-IIa activity in younger children. 23 This is likely due to age-related differences in protein structures affecting the binding of heparin to plasma proteins.…”