Antithrombotic Therapy in Children: Mechanical Prosthetic Heart Valves in Children

Mechanical Prosthetic Heart Valves in Children
1.    It is strongly recommended that children with mechanical prosthetic heart valves receive oral anticoagulation therapy. This grade C2 recommendation is based on grade C recommendations for adults and 13 level V studies in children.
2.    Levels of oral anticoagulation therapy that prolong the INR to 2.5 to 3.5 are recommended based on recommendations in adults.
3.    Children with mechanical prosthetic heart valves who suffer systemic embolism despite adequate therapy with oral anticoagulation therapy may benefit from the addition of aspirin, 6 to 20 mg/kg/d (adult level I study). Dipyridamole, 2 to 5 mg/kg/d, in addition to oral anticoagulation therapy, is an alternative option (adult level I study).
4.    When full-dose oral anticoagulation therapy is contraindicated, long-term therapy with oral anticoagulation therapy sufficient to increase the INR 2.0 to 3.0, in combination with aspirin, 6 to 20 mg/kg/d, and dipyridamole, 2 to 5 mg/kg/d, may be used (grade Cl). This recommendation is an extrapolation of a level I study in adults. There is one level V study in children. natural asthma treatment

Treatment of Kawasaki’s Disease in Children
In addition to IV 7-globulin (2 g4cg as a single dose), children with Kawaski’s disease should receive aspirin, 80 to 100 mg/kg^d during the acute phase (up to 14 days) as an anti-inflammatory agent, then aspirin 3 to 5 mg/kg/d for 7 weeks or longer to prevent the formation of coronary aneurysm thrombosis. This grade Cl recommendation is based on two level III studies.
Fontan Operations
Further clinical investigation is needed before definitive recommendations for primary postoperative prophylaxis can be made. Current options include either aspirin or therapeutic amounts of heparin that are followed by oral anticoagulation dierapy to achieve an INR of 2 to 3. The optimal duration of prophylaxis is unknown. Patients with fenestrations may benefit from treatment until closure.
Blalock-Taussig Shunts
Further clinical investigation is needed before definitive recommendations can be made. One option is to initially treat patients with Blalock-Taussig shunts with therapeutic amounts of heparin, followed by aspirin at doses of 3 to 5 mg/kg/d indefinitely.
Homozygous PC- and PS-Deficient Patients
1.    It is recommended that newborns with purpura fulminans due to a homozygous deficiency of PC or PS should be treated initially widi replacement therapy (either fresh frozen plasma or PC concentrate) for approximately 6 to 8 weeks until the skin lesions have healed.
2.    Following resolution of the skin lesions, and under cover of replacement therapy, oral anticoagulation therapy can be introduced with target INR values of approximately 3 to 4.5. Treatment duration with oral anticoagulants is indefinite. Recurrent skin lesions should be treated with replacement therapy of PC or PS.
3.    For patients with homozygous PC and PS deficiency but with measurable plasma concentrations, LMWH is a therapeutic option.