Clinical Review ABC of antithrombotic therapy

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

BMJ 2003; 326 doi: (Published 11 January 2003) Cite this as: BMJ 2003;326:93
  1. Bernd Jilma,
  2. Sridhar Kamath,
  3. Gregory Y H Lip

    Treatments for children

    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 <16 years unless there are compelling clinical indications. The particular concerns about Reye's syndrome usually seem to be related to higher doses of aspirin (>40 mg/kg).


    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.

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    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 …

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