Low-molecular-weight heparin in pediatric patients with thrombotic disease: A dose finding study☆,☆☆,★,★★
Section snippets
Patient population
From January to December 1994, consecutive pediatric patients from two institutions, the Hospital for Sick Children, Toronto, Canada, and the Children's Hospital at Chedoke/McMaster University Medical Centre, were eligible to receive LMWH if they required anticoagulation therapy but had an increased risk of bleeding with standard heparin. Many children also had limited venous access for administering and monitoring heparin.
Radiologic evaluation
All pediatric patients with suspected deep vein thrombosis, pulmonary
Patient population
Twenty-five consecutive pediatric patients were treated with LMWH; 14 were female. The underlying disorders were cancer (4 patients), infection (3), surgery or other trauma (5), systemic lupus erythematosus (2), Wegener granulomatosis (2), nephrosis (3), congenital heart disease (3), and dehydration (3). Nine patients were less than 2 months of age.
Indications for LMWH therapy
All 25 children received LMWH because their responsible physician assessed the risk of bleeding with standard heparin as excessive or because they
DISCUSSION
Thromboembolic complications are one of the most serious new complications of tertiary care in children.15, 16, 17, 18, 19, 20 Our results show that LMWH is easily administered to children, the dose is age dependent, and the pharmacokinetics are reproducible; minimal monitoring is required. A randomized, controlled trial comparing standard heparin with LMWH to determine safety and efficacy is justified by the results of our study.
The LMWHs are prepared by a variety of methods, including
Acknowledgements
We acknowledge the technical assistance of Mrs. P. Vegh and Mrs. L. Brooker.
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From the Department of Paediatrics, McMaster University, Hamilton, Ontario, and the Divisions of Haematology, Cardiology, Surgery, and Radiology and Department of Haematology, Hospital for Sick Children, Toronto, Ontario, Canada
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Supported by a grant in aid from the Medical Research Council of Canada. Dr. Andrew is a Career Scientist with the Heart and Stroke Foundation of Canada. Dr. Massicotte is a Research Fellow of the Heart and Stroke Foundation.
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Reprint requests: Maureen Andrew, MD, Hamilton Civic Hospitals Research Centre, 711 Concession St., Hamilton, Ontario L8V 1C3, Canada.
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0022-3476/96/$5.00 + 0 9/20/70937