Abstract
Advances in tertiary care pediatrics have resulted in heparin being one of the most
frequently prescribed drugs in children's hospitals. Heparin is essential for cardiopulmonary
bypass, extracorporeal membrane oxygenation, renal dialyses, maintenance of patency
of venous and arterial catheters, and treatment of thromboembolic events. Currently,
protocols validated in adults are used for children. However, optimal use of heparin
in pediatric patients will likely differ from adults because of agedependent physiologic
and pathologic differences in hemostasis that influence the activities of heparin.
The following review summarizes the influence of age on heparin anticoagulant activities,
and pharmacokinetics. The indications, monitoring, therapeutic range, factors influencing
dose-response relationships, and side effects of heparin therapy in pediatric patients
are discussed. Finally the current and future indications for low-molecular-weight
heparins in pediatric patients are summarized. Multicentered, international clinical
trials are urgently needed to assess and optimize the use of heparin in pediatric
patients in a variety of clinical settings. Until these studies are completed, recommendations
for adults provide guidelines for children.
Keywords:
Heparin - thrombosis - treatment - prophylaxis - children - newborns
