Table 8.
Thromboembolic events: therapy and prophylaxis
| Drug | Indication | Dosage | Monitoring |
|---|---|---|---|
| Unfractionated heparin | Begin at the time of the acute event and continue for 5–10 days. Suspend on day 6 after OAT start, if INR on target. (Grad 1C +). Minor use in the last decade. |
75 UI/kg bolus in10 min Initial maintenance dose: >1 year: 28 UI/Kg/h >1 year. 20 UI/Kg/h Then adjust to maintain aPTT between 60–85 s. |
aPTT Therapeutic target: between 60–85 s. |
| Low molecular weight heparin (LMWH) | More used in the last decade in the treatment of thromboembolism in children | Enoxaparin Dosage (>2 months) Therapeutic: 100 UI/kg every 12 h Prophylactic: 50 UI/ kg every 12 h If clearance <60 ml/min) dosage must be adjusted on renal function |
Anti Xa: blood samples 4 h after drug administration Therapeutic target: 0.5.1 UI/mL Prophylactic target: 0.3-0.5 UI/mL |
| Oral anticoagulants (warfarin) |
Begin with heparin therapy until the target INR(2–3) is reached. Continue for 3 months, in absence of predisposing factors like NS. Continue for 6 months in presence of predisposing factors, like NS, or in cases of recurrent thrombosis. Vitamin K antagonists more used for older children (frequent blood check) |
In pediatric patients > 10 Kg: 0.2 mk/Kg/day (For dosage adjustment, see Chest 2012 [61] and Paediatr Drugs 2015 [63] |
INR Target: 2-3 |
| Aspirin | If PLT >1.000.000 /mmc with concomitant NS | Empirical antiplatelet dosage in pediatrics: 1–5 mg/kg/day | |
| Fibrinolytic agents | No data on fibrinolytic treatment of thrombotic events in pediatric patients with NS. Use only in selected cases (urokinase, tPA) according to published recommendations [60, 61] |