Antithrombotic Therapy in Children: Treatment of Venous/Arterial Thromboembolism in Newborns
5. Indefinite oral anticoagulant therapy with an INR of 2.0 to 3.0 should be considered for children with a second recurrence of venous thrombosis or a first recurrence of a venous thrombosis and a continuing risk factor, such as a CVL, AT deficiency, PC or PS deficiency, activated PC resistance, prothrombin gene 20210, lupus anticoagulants in the antiphospholipid antibody syndrome, or systemic lupus erythematosus. In circumstances in which oral anticoagulation therapy is problematic, LMWH is an option.
6. The use of thrombolytic agents in the treatment of VTE continues to be highly individualized. Further clinical investigation is needed before more definitive recommendations can be made.
7. Children with congenital prothrombotic disorders should receive short-term prophylactic anticoagulation in high-risk situations such as immobility, significant surgery, or trauma.
Treatment of Venous/Arterial Thromboembolism in Newborns
1. The use of anticoagulation therapy in the treatment of newborns with DVT, PE, or arterial thrombosis continues to be highly individualized. Further clinical investigation is needed before more definite recommendations can be made.
2. If short-term anticoagulation therapy is not used, the tiirombus should be closely monitored with objective tests and if extending, anticoagulation therapy should be instituted.
3. If anticoagulation is used, a short course (10 to 14 days) of IV heparin, sufficient to prolong the APTT to the therapeutic range that corresponds to an anti-factor Xa level of 0.3 to 0.7 U/mL is recommended. Flovent inhaler in detail Alternatively, a short course of LMWH, sufficient to achieve an anti-factor Xa level at the low end of the adult therapeutic range (0.5 to 1.0 U/mL) may be used. The thrombus should be closely monitored with objective tests for evidence of extension or recurrent disease.- If the thrombus extends following discontinuation of heparin therapy, oral anticoagulation therapy orex-tended LMWH should be considered.
4. The use of thrombolytic agents in the treatment of VTE continues to be highly individualized. Further clinical investigation is needed before more definitive recommendations can be made. Supplementation with plasminogen (FFP) may be helpful.
Prophylaxis for Cardiac Catheterization in Children and Newborns
Newborns and children requiring cardiac catheterization via an artery should be given prophylaxis with IV heparin in doses of 100 to 150 U/kg as a bolus. This grade B2 recommendation is based on one level II study in children slO years of age.196 Aspirin alone cannot be recommended (one level II study).