Department of Paediatric Haematology, Sheffield Children's Hospital, Sheffield, UK.
Br J Haematol. 2010 Aug;150(3):259-77. doi: 10.1111/j.1365-2141.2010.08225.x. Epub 2010 May 26.
The number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.
接受抗凝治疗的儿童人数正在增加。血栓栓塞事件与较高的发病率和死亡率相关，尽管无症状事件的最佳管理仍不清楚。儿科的具体挑战包括血栓的诊断、从新生儿到青少年的各种年龄段的抗凝治疗的实施和监测。儿童年龄增长导致止血系统的发展，从而改变了血栓形成的病理生理学和对抗凝药物的反应。尽管登记和观察性研究提供了重要信息，但专门的儿科抗凝前瞻性研究很少且设计有限。结果是，目前的许多实践都是从成人研究中推断出来的。传统的抗凝剂有很大的局限性。肝素和华法林广泛使用，但关于剂量、治疗范围、疗效和最佳持续时间的许多基本问题尚未得到充分解答。替代药物，如直接凝血酶抑制剂和选择性抗因子 Xa 抑制剂磺达肝素，可能对儿童有优势。成人临床试验和儿童初步数据很有希望，但在特定的儿科研究证明安全性和疗效之前，应谨慎应用。
