Department of Pediatric Hematology Oncology, University of Kentucky, Lexington, Kentucky.
Semin Thromb Hemost. 2017 Nov;43(8):877-885. doi: 10.1055/s-0036-1598004. Epub 2017 Mar 27.
Venous thromboembolism (VTE) is very uncommon in children and adolescents compared with older adults, though its incidence has significantly increased over the past two decades. Given the rarity of the condition, the data on pediatric VTE lag behind the adult experience and consequently the management of VTE in children is, in large part, modeled on the adult strategies. This approach has certain limitations, given that young children have developmental particularities of the hemostatic system and differences in the pharmacokinetics and pharmacodynamics of various anticoagulant agents. The most commonly used anticoagulants in children continue to be the heparins and the vitamin K antagonists. Direct intravenous thrombin inhibitors, argatroban, bivalirudin, have very limited pediatric use. The non-vitamin K antagonist oral anticoagulant drugs (novel oral anticoagulants) present potential advantages in terms of efficacy, safety, and convenience, though pediatric data are limited to preclinical and small phase I trials. There are several ongoing phase I, II, and III trials for dabigatran rivaroxaban, apixaban, and edoxaban, the results of which are likely to change the future management of pediatric thromboses.
静脉血栓栓塞症（VTE）在儿童和青少年中非常罕见，与老年人相比，尽管在过去二十年中其发病率显著增加。鉴于该疾病的罕见性，儿科 VTE 的数据落后于成人经验，因此儿童 VTE 的管理在很大程度上是基于成人策略。这种方法存在一定的局限性，因为幼儿的止血系统具有发育特殊性，以及各种抗凝剂的药代动力学和药效动力学存在差异。儿童最常用的抗凝剂仍然是肝素和维生素 K 拮抗剂。直接静脉注射凝血酶抑制剂、阿加曲班、比伐卢定在儿科的使用非常有限。非维生素 K 拮抗剂口服抗凝药物（新型口服抗凝药物）在疗效、安全性和便利性方面具有潜在优势，尽管儿科数据仅限于临床前和 I 期小型试验。目前正在进行几项达比加群、利伐沙班、阿哌沙班的 I、II 和 III 期试验，其结果可能会改变儿科血栓形成的未来管理。
