Revel-Vilk Shoshana, Chan Anthony K C
Pediatric Hematology/ Oncology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Semin Thromb Hemost. 2003 Aug;29(4):425-32. doi: 10.1055/s-2003-42592.
Thromboembolic events (TEs) in children are rare but are becoming a recognized cause of morbidity and mortality, particularly in children with serious underlying primary conditions such as congenital heart disease, cancer, or prematurity. Neonates, infants, and adolescents are most at risk for developing TEs among children, and the presence of a central venous line or intra-arterial catheter is the most significant risk factor for TEs in children. Hemostatic differences between children and adults affect both the pathophysiology of the thrombotic process and the response to anticoagulant therapy. In this article, we focus on the impact of the developmental hemostatic system on responses to anticoagulants in children. The most commonly used anticoagulants in children are unfractionated heparin, low-molecular-weight heparins, and warfarin. Minimal experience exists with the use of the new antithrombotic agents in children. As the anticoagulant treatment used for TEs in children is largely adopted from clinical trials performed in adult populations, well-designed prospective trials are required to establish the optimal therapy for children with TEs.
儿童血栓栓塞事件（TEs）虽罕见，但已成为公认的发病和死亡原因，尤其是在患有先天性心脏病、癌症或早产等严重潜在原发性疾病的儿童中。新生儿、婴儿和青少年是儿童中发生TEs风险最高的群体，中心静脉导管或动脉内导管的存在是儿童发生TEs的最主要风险因素。儿童与成人在止血方面的差异影响血栓形成过程的病理生理学以及对抗凝治疗的反应。在本文中，我们重点关注发育中的止血系统对儿童对抗凝剂反应的影响。儿童最常用的抗凝剂是普通肝素、低分子肝素和华法林。在儿童中使用新型抗血栓药物的经验极少。由于用于儿童TEs的抗凝治疗很大程度上借鉴了在成人中进行的临床试验，因此需要精心设计的前瞻性试验来确定儿童TEs的最佳治疗方案。
