Niedermolekulare Heparine in der Pädiatrie

Zusammenfassung

Die Thrombose im Kindesalter stellt ein seltenes Ereignis dar. Fortschritte operativer Methoden v.a. in der Transplantationsmedizin und der Herzchirurgie bei Kindern resultieren jedoch in einem steigenden Bedarf an einer effektiven antithrombotischen Prophylaxe. Zudem gehen Verbesserungen diagnostischer Möglichkeiten mit einer Zunahme der Diagnose »Thrombose« auch in der Pädiatrie einher. Hier konnten sich in den letzten Jahren niedermolekulare Heparine auf verschiedensten pädiatrischen Teilgebieten ihren Stellenwert als sichere und effektive Alternative zu unfraktioniertem Heparin oder oralen Antikoagulanzien in Prophylaxe und Therapie arterieller und venöser Thrombosen sichern.

Summary

Thrombosis in childhood is a rare event. Increasing sophistication of technical equipment, however, results in an increasing diagnosis of thrombosis even in childhood. Furthermore, improvement of operation techniques in pediatrics mainly in the fields of transplantation and cardial surgery causes a strong requirement for effective antithrombotic prophylaxis. In the last years low-molecular-weight heparins were found to be an effective and safe alternative to unfractionated heparin as well as oral anticoagulants in prophylaxis and therapy of arterial and venous thromboembolism in many fields of pediatrics.

Schlüsselwörter

Niedermolekulares Heparin - Kinder - Thrombosen

Keywords

Low-molecular-weight heparins - children - thrombosis

• Literatur

• 1 Andrew M, Monagle PT, Brooker L. Thromboembolic complications during infancy and childhood. Hamilton, London: B.C. Decker Inc.; 2000
• 2 Andrew M, Halton J, Massicotte P. Treatment of homozygous protein C deficiency in two children with low molecular weight heparin (LMWH) therapy. Thromb Haemost 1995; 73: 939.
• 3 Andrew M. A randomized control trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children: the PROTEKT trial. Blood 2000; 96 Abstract 2116.
• 4 Attal M, Huguet F, Rubie H, Huynh A, Charlet JP, Payen JL, Voigt JJ, Brousset P, Selves J, Muller C, Pris J, Laurent G. Prevention of hepatic veno-occlusive disease after bone marrow transplantation by continuous infusion of low-dose heparin: a proespective, randomized trial. Blood 1992; 79: 2834-40.
• 5 Bianchetti MG, Speck S, Müller R, Oetliker OH. Simple coagulation prophylaxis using low-molecular heparin enoxaparin in pediatric hemodialysis. Schweiz Rundsch Med Prax 1990; 79: 730-1.
• 6 Bökenkamp A, Hoyer PF, Nowak-Göttl U, von Kries R. Therapie und Prognose neonataler Nierenvenenthombosen in Deutschland 1992-1994. Monatsschr Kinderheilkd 1995; 143 (Suppl. 03) S 196.
• 7 Broyer M, Gagnadoux MF, Sierro A, Fischer AM, Revillon Y, Jan D, Beurton D, Niaudet P. Preventive treatment of vascular thrombosis after kidney transplantation in children with low molecular weight heparin. Transplantation Proceedings 1991; 23: 1384-5.
• 8 Broyer M, Gagnadoux MF, Sierro A, Fischer AM, Revillon Y, Jan D, Beurton D, Niaudet P. Prevention of vascular thromboses after renal transplantation using low molecular weight heparin. Ann Pediatr Paris 1991; 38: 397-9.
• 9 Chevalier RL. Ask the expert: what treatment do you advise for bilateral and unilateral renal thrombosis in the newborn, with or without thrombosis of the inferior vena cava?. Pediatr Nephrol 1991; 5: 679.
• 10 Day RW, Broyer RS, Tait VF, Ruttenberg HD. Factors associated with stroke following the Fontan procedure. Pediatr Cardiol 1995; 16: 270-5.
• 11 deVeber G, MacGregor D, Curtis R, Stephens D. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child neurol 2000; 15: 316-24.
• 12 deVeber G, Chan A, Monagle P, Marzinott V, Armstrong D, Massicotte P, Leaker M, Andrew M. Anticoagulation therapy in pediatric patients with sinovenous thrombosis. Arch Neurol 1998; 55: 1533-7.
• 13 Dix D, Andrew M, Marzinotto V, Charpentier. Bridge S, Monagle P, deVeber G, Leaker M, Chan AKC, Massicotte MP. The use of low molecular weight heparin in pediatric patients: A prospective cohort study. J Pediatr 2000; 136: 439-45.
• 14 Dzumhur SM, Goss DE, Cohen AT. Low-molecular-weight heparin for venous thrombosis in a neonate. Lancet 1995; 346: 1487.
• 15 Fijnvandraat K, Nurmohamed M, Peters M, Ploos van Amstel S, ten Cate J. A cross-over dose finding study investigating a low molecular weight heparin (FragminÒ) in six children on chronic hemodialysis. Thromb Haemost 1993; 69: 649.
• 16 Gagnadoux MF, Charbit M, Beurton D, Revillon Y, Niaudet P, Broyer M. Renal transplantation in children under five years of age. Experience at the Hopital des Enfants-Malades. Ann Pediatr Paris 1993; 40: 108-11.
• 17 Hashikura Y, Kawasaki S, Okumura N, Ishikawa S, Matsunami H, Ikegami T, Nakazawa Y, Makuuchi M. Prevention of hepatic artery thrombosis in pediatric liver transplantation. Transplantation 1995; 60: 1109-12.
• 18 Kehl HG, Schaudin E, Vielhaber H, Postler C, Ernst R, Jürgens H, Nowak-Götl U. Long-term LMWH (Enoxaparin) anticoagulation during infancy and childhood. Ann Hematol 1996; 72 (Suppl. 01) A 44.
• 19 Kock HJ, Schmit-Neuerburg KP, Hanke J, Hakman A, Althoff M, Rudofsky M, Hirche H. Ambulante Thromboseprophylaxe mit niedermolekularem Heparin bei Gipsimmobilisation der unteren Extremität. Hämostaseologie 1993; 13: S36-9.
• 20 Massicotte P, Adams M, Marzinotto V, Brooker LA, Andrew M. Low-molecular weight heparin in pediatric ptients with thrombotic disease: A dose finding study. J Pediatr 1996; 128: 313-8.
• 21 Massicotte MP, Adams M, Leaker M, Andrew M. A nomogram to establish therapeutic levels of the low molecular weight heparin (LMWH), clivarine in children requiring treatment for venous thromboembolism (VTE). Thromb Haemost 1997; Suppl: 282 (Abstr.).
• 22 Michelson AD, Bovill E, Monagle P, Andrew M. Antithrombotic therapy in children. Chest 1998; 114: 748S-769S.
• 23 Nohe N, Flemmer A, Ruemler R, Praun M, Auberger K. The low molecular weight heparin dalteparin for prophylaxis and therapy of thrombosis in childhood: a report on 48 cases. Eur J Pediatr 1999; 158: S 134-9.
• 24 Nowak-Göttl U, Kries von R, Göbel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child 1997; 76: F163-7.
• 25 Or R, Nagler A, Shpilberg O, Elad S, Naparstek E, Kapelushnik J, Cass Y, Gillis S, Chetrit A, Slavin S, Eldor A. Low molecular weight heparin for the prevention of veno-occlusive disease of the liver in bone marrow transplantation patients. Transplantation 1996; 61: 1067-71.
• 26 Piquet P, Laporte-Simitsidis S, Doubine S, Mismetti P, Houyel L, Decousus H. Predicitive enoxaparin (Lovenox) dosage regimens in neonates and children after cardiovascular surgery. Thromb Haemost 1995; 73: 972.
• 27 Van Biljon I, Van Damme-Lombaerts R, Demol A, Van Geet C, Proesmans W, Arnout J. Low molecular weight heparin for anticoagulation during hemodialysis in children – a preliminary study. Eur J Pediatr 1996; 155: 70.
• 28 Vieira A, Ofosu F, Andrew M. The activity of low molecular weight heparin (CY222) in neonatal plasma. Thromb Haemost 1991; 63: 85-98.
• 29 Willital GH, Tsokas J. Derzeitiger Stand der Thromboembolieprophylaxe nach chirurgischen Eingriffen bei Kindern und Jugendlichen. Klinik und Wissenschaft 1995; 5: 1-4.