Department of Clinical Haematology, Royal Children's Hospital, Haematology Research Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, and.
Department of Clinical Haematology, Royal Children's Hospital, Haematology Research Murdoch Children's Research Institute, School of Nursing, University of Melbourne, Melbourne, VIC, Australia.
Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):399-404. doi: 10.1182/asheducation-2018.1.399.
Venous thrombosis (VTE) in children and neonates presents numerous management challenges. Although increasing in frequency, VTE in children and neonates is still uncommon compared with adults. The epidemiology of VTE is vastly different in neonates vs children vs adolescents vs adults. In reality, pediatric thrombosis should be viewed as a multitude of rare diseases (eg, renal vein thrombosis, spontaneous thrombosis, catheter-related thrombosis, cerebral sinovenous thrombosis), all requiring different approaches to diagnosis and with different short- and long-term consequences, but linked by the use of common therapeutic agents. Further, children have fundamentally different physiology in terms of blood flow, developmental hemostasis, and, likely, endothelial function. provides up-to-date evidence-based guidelines related to treatment. Therefore, this article will focus on the practical use of therapeutic agents in the management of pediatric VTE, especially unfractionated heparin, low-molecular-weight heparin, and oral vitamin K antagonists, as the most common anticoagulants used in children. Direct oral anticoagulants (DOACs) remain in clinical trials in children and should not be used outside of formal trials for the foreseeable future.
儿童和新生儿的静脉血栓形成 (VTE) 带来了诸多管理挑战。尽管 VTE 在儿童和新生儿中的发病率正在增加，但与成人相比，其发病率仍然较低。VTE 在新生儿、儿童、青少年和成人中的流行病学情况有很大的不同。实际上，儿科血栓形成应被视为多种罕见疾病（例如，肾静脉血栓形成、自发性血栓形成、导管相关血栓形成、脑静脉窦血栓形成），所有这些疾病都需要不同的诊断方法，具有不同的短期和长期后果，但都通过使用共同的治疗药物联系在一起。此外，儿童的血流、发育性止血和内皮功能在生理学上有根本的不同。本文提供了与治疗相关的最新循证指南。因此，本文将重点介绍治疗儿科 VTE 中治疗药物的实际应用，尤其是未分级肝素、低分子量肝素和口服维生素 K 拮抗剂，因为它们是儿童最常用的抗凝剂。直接口服抗凝剂（DOAC）仍在儿童临床试验中，在可预见的未来，不应在正式试验之外使用。
