Abstract
Venous thromboembolism (VTE) is very uncommon in children and adolescents compared
with older adults, though its incidence has significantly increased over the past
two decades. Given the rarity of the condition, the data on pediatric VTE lag behind
the adult experience and consequently the management of VTE in children is, in large
part, modeled on the adult strategies. This approach has certain limitations, given
that young children have developmental particularities of the hemostatic system and
differences in the pharmacokinetics and pharmacodynamics of various anticoagulant
agents. The most commonly used anticoagulants in children continue to be the heparins
and the vitamin K antagonists. Direct intravenous thrombin inhibitors, argatroban,
bivalirudin, have very limited pediatric use. The non–vitamin K antagonist oral anticoagulant
drugs (novel oral anticoagulants) present potential advantages in terms of efficacy,
safety, and convenience, though pediatric data are limited to preclinical and small
phase I trials. There are several ongoing phase I, II, and III trials for dabigatran
rivaroxaban, apixaban, and edoxaban, the results of which are likely to change the
future management of pediatric thromboses.
Keywords
venous thromboembolism - children - anticoagulation
