Antithrombotic Therapy in Children: Indications for Antithrombotic Therapy in Pediatric Patients
Treatment of Bleeding Due to Thrombolytic Therapy: Before thrombolytic therapy is used, it is advisable, when possible, to correct other concurrent hemostatic problems, such as thrombocytopenia or vitamin K deficiency. Clinically mild bleeding, which is usually oozing from a wound or puncture site, can be treated with local pressure and supportive care. Major bleeding from a local site can be treated by stopping the infusion of thrombolytic agent and administering cryoprecipitate (usual dose of 1 bag/5 kg) and other blood products as indicated. If the bleeding is life threatening, an antifibrinolytic agent can also be used.
Indications for Antithrombotic Therapy in Pediatric Patients
Although the general indications for antithrombotic therapy in pediatric patients are similar to adults, the frequency of specific disease states and underlying pathologies differ. For example, myocardial infarction and cerebrovascular accidents (CVA) are two of the more common indications for antithrombotic therapy in adults and are the least common in children. The current indications for antithrombotic therapy in children are provided in Table 10.
Venous Thromboembolic Disease
Incidence: The incidence of venous thromboembolic complications (DVT/PE) is age dependent, with the lowest risk occurring in children. Estimates of the incidence of DVT/PE in the general pediatric population are between 0.07/10,000 and 5.3/10,000 hospital admissions Reading here buy ventolin inhaler. Comparable incidences of DVT/PE in the adult population are approximately 2.5 to 5.0%. Other comparisons illustrating the lower risk of DVT/PE during childhood are <1% incidence of clinically apparent DVT/PE following lower limb or scoliosis surgery; and the low frequency of DVT/PE in children with heterozygote congenital prethrombotic states. Several mechanism (s) likely contribute to the protective effect of age for DVT/PE. These include a reduced capacity to generate thrombin,9123 increased capacity of a2-macroglobulin to inhibit thrombin, presence of a circulating anticoagulant at birth, and others, such as enhanced antithrombotic potential by the vessel wall.
Table 10—Indications for Antithrombotic Agents in Pediatric Patients
|Venous thromboembolic complications Arterial thromboembolic complications|
|II. Treatment: probable|
|JlMyocardial infarction Some forms of stroke|
|Mechanical prosthetic heart valves Biological prosthetic heart valves Cardiac catheterization Central arterial catheters|
|IV. Prophylaxis: probable|
|Endovascular stents Blalock-Taussig shunts Fontans operation Central venous catheters Atrial venous fibrillation|
|Kawasaki’s disease Cardiopulmonary bypass Extracorporeal membrane oxygenation HemodialysisContinuous veno-venous hemoperfusion|