Anticoagulation therapy in children

Thromboembolic events (TEs) in children are rare but are becoming a recognized cause of morbidity and mortality, particularly in children with serious underlying primary conditions such as congenital heart disease, cancer, or prematurity. Neonates, infants, and adolescents are most at risk for developing TEs among children, and the presence of a central venous line or intra-arterial catheter is the most significant risk factor for TEs in children. Hemostatic differences between children and adults affect both the pathophysiology of the thrombotic process and the response to anticoagulant therapy. In this article, we focus on the impact of the developmental hemostatic system on responses to anticoagulants in children. The most commonly used anticoagulants in children are unfractionated heparin, low-molecular-weight heparins, and warfarin. Minimal experience exists with the use of the new antithrombotic agents in children. As the anticoagulant treatment used for TEs in children is largely adopted from clinical trials performed in adult populations, well-designed prospective trials are required to establish the optimal therapy for children with TEs.