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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Anticoagulation and Thrombolysis

Giglia, Therese M. MD, FACC, FAAP, SCCM; Witmer, Char MD; Procaccini, David E. PharmD, BCPS; Byrnes, Jonathan W. MD

doi: 10.1097/PCC.0000000000000623
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Objective: Thrombotic complications are increasingly being recognized as a significant cause of morbidity and mortality in pediatric and congenital heart disease. The objective of this article is to review the medications currently available to prevent and treat such complications.

Data Sources: Online searches were conducted using PubMed.

Study Selection: Studies were selected for inclusion based on their scientific merit and applicability to the pediatric cardiac population.

Data Extraction: Pertinent information from each selected study or scientific review was extracted for inclusion.

Data Synthesis: Four classes of medications were identified as potentially beneficial in this patient group: anticoagulants, antiplatelet agents, thrombolytic agents, and novel oral anticoagulants. Data on each class of medication were synthesized into the follow sections: mechanism of action, pharmacokinetics, dosing, monitoring, reversal, considerations for use, and evidence to support.

Conclusions: Anticoagulants, antiplatelet agents, and thrombolytic agents are routinely used successfully in the pediatric patient with heart disease for the prevention and treatment of a wide range of thrombotic complications. Although the novel oral anticoagulants have been approved for a limited number of indications in adults, studies on the safety and efficacy of these agents in children are pending.

1Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

2Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

3Department of Pediatrics, Pediatric Pharmacy, Johns Hopkins Medical Center, Baltimore, MD.

4Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.

Dr. Witmer disclosed off-label product use: All anticoagulants but one are off label. Dr. Byrnes’ institution received support from Daiichi-Sanyo (Edoxaban) (no direct financial support, but site PI for a phase I study. Dr. Byrnes’ portion of the article had no mention of this or related products). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: gigliat@email.chop.edu

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies