Clopidogrel use in children

Background Children with congenital heart lesions have an increased incidence of thrombotic complications, particularly after interventional catheterization procedures. Clopidogrel is a specific platelet aggregation inhibitor. It selectively blocks the binding of membrane ADP to its platelet receptor. Dual therapy with aspirin and clopidogrel is the preferred antithrombotic regimen after coronary intervention with stent placement in adults. We describe the first experience with clopidogrel in children with complex heart disease after interventional cardiac catheterization and suggest a dose regimen for a pediatric population. Methods A retrospective study of all infants and children treated with clopidogrel bisulphate in the Hospital for Sick Children, Toronto between Jan. 2001 and April 2004. Clopidogrel dosages, duration of therapy, complications and adverse effects were explored. Results 15 infants and children with congenital and acquired heart disease were treated with clopidogrel (median age 3.5 years; range 6 weeks- 16 years). Dosages ranged from 1 to 6 mg/kg/day, for periods between 1 to 6 months. While no thrombotic events were reported, one child had a bleeding complication (gastrointestinal) while on triple antithrombotic therapy (warfarin, aspirin and clopidogrel). Other complications reported in adults were not noted in this pediatric series. Conclusions Clopidogrel was well tolerated. A dose of 1mg/kg/day for children, may be started with monitored bleeding time. Clinical Pharmacology & Therapeutics (2005) 77, P54–P54; doi: 10.1016/j.clpt.2004.12.098