PMID- 18574281
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20170602
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 6 Suppl
DP  - 2008 Jun
TI  - Antithrombotic therapy in neonates and children: American College of Chest 
      Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).
PG  - 887S-968S
LID - S0012-3692(08)60133-6 [pii]
LID - 10.1378/chest.08-0762 [doi]
AB  - This chapter about antithrombotic therapy in neonates and children is part of the 
      Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians 
      Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 
      recommendations are strong and indicate that the benefits do, or do not, outweigh 
      risks, burden, and costs, and Grade 2 suggests that individual patient values may 
      lead to different choices (for a full understanding of the grading, see Guyatt et 
      al in this supplement, pages 123S-131S). In this chapter, many recommendations 
      are based on extrapolation of adult data, and the reader is referred to the 
      appropriate chapters relating to guidelines for adult populations. Within this 
      chapter, the majority of recommendations are separate for neonates and children, 
      reflecting the significant differences in epidemiology of thrombosis and safety 
      and efficacy of therapy in these two populations. Among the key recommendations 
      in this chapter are the following: In children with first episode of venous 
      thromboembolism (VTE), we recommend anticoagulant therapy with either 
      unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) [Grade 1B]. 
      Dosing of IV UFH should prolong the activated partial thromboplastin time (aPTT) 
      to a range that corresponds to an anti-factor Xa assay (anti-FXa) level of 0.35 
      to 0.7 U/mL, whereas LMWH should achieve an anti-FXa level of 0.5 to 1.0 U/mL 4 h 
      after an injection for twice-daily dosing. In neonates with first VTE, we suggest 
      either anticoagulation or supportive care with radiologic monitoring and 
      subsequent anticoagulation if extension of the thrombosis occurs during 
      supportive care (Grade 2C). We recommend against the use of routine systemic 
      thromboprophylaxis for children with central venous lines (Grade 1B). For 
      children with cerebral sinovenous thrombosis (CSVT) without significant 
      intracranial hemorrhage (ICH), we recommend anticoagulation initially with UFH, 
      or LMWH and subsequently with LMWH or vitamin K antagonists (VKAs) for a minimum 
      of 3 months (Grade 1B). For children with non-sickle-cell disease-related acute 
      arterial ischemic stroke (AIS), we recommend UFH or LMWH or aspirin (1 to 5 
      mg/kg/d) as initial therapy until dissection and embolic causes have been 
      excluded (Grade 1B). For neonates with a first AIS, in the absence of a 
      documented ongoing cardioembolic source, we recommend against anticoagulation or 
      aspirin therapy (Grade 1B).
FAU - Monagle, Paul
AU  - Monagle P
AD  - From the Haematology Department, The Royal Children's Hospital and Department of 
      Pathology, The University of Melbourne, Melbourne, VIC, Australia. Electronic 
      address: paul.monagle@rch.org.au.
FAU - Chalmers, Elizabeth
AU  - Chalmers E
AD  - Consultant Pediatric Hematologist, Royal Hospital for Sick Children, Glasgow, UK.
FAU - Chan, Anthony
AU  - Chan A
AD  - Henderson Research Centre, Hamilton, ON, Canada.
FAU - deVeber, Gabrielle
AU  - deVeber G
AD  - Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada.
FAU - Kirkham, Fenella
AU  - Kirkham F
AD  - Neurosciences Unit, Institute of Child Health, London, UK.
FAU - Massicotte, Patricia
AU  - Massicotte P
AD  - Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada.
FAU - Michelson, Alan D
AU  - Michelson AD
AD  - Center for Platelet Function Studies, University of Massachusetts Medical School, 
      Worcester, MA.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 12001-79-5 (Vitamin K)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aspirin/administration & dosage/therapeutic use
MH  - Child
MH  - Drug Therapy, Combination
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/*therapeutic use
MH  - Humans
MH  - Infant, Newborn
MH  - Partial Thromboplastin Time
MH  - Risk Assessment
MH  - Risk Factors
MH  - Venous Thrombosis/*drug therapy
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2008/07/24 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/24 09:00
PHST- 2008/07/24 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/24 09:00 [entrez]
AID - S0012-3692(08)60133-6 [pii]
AID - 10.1378/chest.08-0762 [doi]
PST - ppublish
SO  - Chest. 2008 Jun;133(6 Suppl):887S-968S. doi: 10.1378/chest.08-0762.