Anticoagulation in neonates and children: Pitfalls and dilemmas

Monagle, Paul; Newall, Fiona; Campbell, Janine

doi:10.1016/j.blre.2010.06.003

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Volume 24, Issue 4 , Pages 151-162, July 2010

Anticoagulation in neonates and children: Pitfalls and dilemmas

Paul Monagle
- Department of Clinical Haematology, Royal Children's Hospital, Australia
- Department of Paediatrics, The University of Melbourne, Australia
- Haematology Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
- Corresponding author. Royal Children's Hospital, Flemington Rd., Parkville, Melbourne, Victoria 3052, Australia. Tel.: +61 3 9345 5914; fax: +61 3 9349 1819.
Fiona Newall
- Department of Clinical Haematology, Royal Children's Hospital, Australia
- Department of Paediatrics, The University of Melbourne, Australia
- Haematology Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia
- Department of Nursing, University of Melbourne, Australia
- Tel.: +61 3 9345 5914; fax: +61 3 9349 1819.
Janine Campbell
- Department of Clinical Haematology, Royal Children's Hospital, Australia
- Tel.: +61 3 9345 5914; fax: +61 3 9349 1819.

published online 21 July 2010.

Abstract

Anticoagulation in children is problematic for many reasons, related to the patient population as well as the anticoagulant drugs themselves. This paper describes the multitude of reasons why providing anticoagulation therapy in children is different from anticoagulation therapy in adults, and hence why dedicated paediatric anticoagulant services are the ideal structure to provide this service. The paper then describes the three most common anticoagulants used in children, and details specifically what is and is not known about them in the paediatric population. Finally the paper addresses the issue of how best to introduce newer anticoagulant drugs into the paediatric population. There remains much research to be done in this field, in the meantime clinicians need to carefully consider the evidence available to them and manage each individual patient accordingly.

Keywords: Children, Neonates, Anticoagulation, Unfractionated heparin, Vitamin K antagonists, Low molecular weight heparins