Antithrombotic therapy in special circumstances. II—In children, thrombophilia, and miscellaneous conditions

Most of the recommendations on antithrombotic therapy in children are based on the extrapolation of results from randomised studies of adults or from small cross sectional, and mainly retrospective, clinical studies of children. Although antithrombotic therapy in children usually follows the same indications as in adults, the distribution of diseases requiring antithrombotic therapy differs in the paediatric population. For example, some predisposing factors for thromboembolism are encountered only in paediatric populations. Most of the indications for antithrombotic therapy in children arise because of an underlying medical disorder or an intervention for the management of the disorder. Management of antithrombotic therapy in children differs from that in adults because of ongoing changes in physiology that may alter the thrombotic process and potentially influence the response of the body to antithrombotic therapy. Indications for antithrombotic therapy in children ### Drug treatments #### Antiplatelet treatment Aspirin, dipyramidole, and indomethacin are probably the most used antiplatelet treatments among children. Low doses of aspirin (antiplatelet doses) usually have minimal side effects in children, but in general aspirin should not be prescribed to children aged 40 mg/kg). #### Heparin Heparin is probably the most commonly used antithrombotic drug in children. Varying concentrations of antithrombin in the body during different developmental stages mean that the therapeutic concentration of heparin in children has to be maintained by regular checks of the activated partial thromboplastin time (APTT) or anti-Xa concentrations. The recommended therapeutic level of APTT is the one which corresponds to a heparin concentration of 0.2-0.4 U/ml or an anti-Xa concentration of 0.3-0.7 U/ml. View this table: Adjusting low molecular weight heparin in children In children, the advantages of low molecular weight heparin over unfractionated heparin are similar to those in adults. In addition, low …