Children's Hospital Los Angeles, University of Southern California Keck School of Medicine.
Department of Paediatrics, Medical University of Vienna, Vienna, Austria.
Blood Cells Mol Dis. 2017 Sep;67:48-53. doi: 10.1016/j.bcmd.2017.05.003. Epub 2017 May 6.
Thrombotic complications are increasing at a steady and significant rate in children resulting in the more widespread use of anticoagulation in this population. Anticoagulant drugs in children can be divided into the standard agents (heparin, low molecular weight heparin, and vitamin K antagonists) and alternative agents (argatroban, bivalirudin, and fondaparinux). This review will compare and contrast the standard and alternative anticoagulants and suggest situations in which it may be appropriate to use argatroban, bivalirudin, and fondaparinux. Clearly, the standard anticoagulants all have significant shortcomings including variable pharmacokinetics, issues with therapeutic drug monitoring, frequency of administration, efficacy, and adverse effects. The alternative anticoagulants have properties which overcome these shortcomings and prospective clinical trial data are presented supporting the current and future use of these agents in place of the standard anticoagulants.
血栓并发症在儿童中以稳定且显著的速度增加，导致该人群更广泛地使用抗凝治疗。儿童用抗凝药物可分为标准药物（肝素、低分子量肝素和维生素 K 拮抗剂）和替代药物（阿加曲班、比伐卢定和磺达肝癸钠）。这篇综述将比较和对比标准和替代抗凝药物，并提出在哪些情况下使用阿加曲班、比伐卢定和磺达肝癸钠可能是合适的。显然，所有标准抗凝药物都有明显的缺点，包括药代动力学的可变性、治疗药物监测的问题、给药频率、疗效和不良反应。替代抗凝药物具有克服这些缺点的特性，目前和未来的临床试验数据支持这些药物替代标准抗凝药物的使用。
