PMID- 27820879
OWN - NLM
STAT- MEDLINE
DCOM- 20161221
LR  - 20220330
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
VI  - 11
IP  - 11
DP  - 2016 Nov 7
TI  - Heparin for the treatment of thrombosis in neonates.
PG  - CD012185
LID - CD012185
AB  - BACKGROUND: Among pediatric patients, newborns are at highest risk of developing 
      thromboembolism. Neonatal thromboembolic (TE) events may consist of both venous 
      and arterial thromboses and often iatrogenic complications (eg, central 
      catheterization). Treatment guidelines for pediatric patients with TE events most 
      often are extrapolated from the literature regarding adults. Options for the 
      management of neonatal TE events include expectant management; nitroglycerin 
      ointment; thrombolytic therapy or anticoagulant therapy, or a combination of the 
      two; and surgery. Since the 1990s, low molecular weight heparin (LMWH) has become 
      the neonatal anticoagulant of choice. Reasons for its appeal include predictable 
      dose response, no need for venous access, and limited monitoring requirements. 
      The overall major complication rate is around 5%. Whether preterm infants are at 
      increased risk is unclear. No data are available on the frequency of 
      osteoporosis, heparin-induced thrombocytopenia (HIT), or other hypersensitivity 
      reactions in children and neonates exposed to LMWH. OBJECTIVES: To assess whether 
      heparin treatment (both unfractionated heparin [UFH] and LMWH) reduces mortality 
      and morbidity rates in preterm and term newborn infants with diagnosed 
      thrombosis. The intervention is compared with placebo or no treatment. Also, to 
      assess the safety of heparin therapy (both UFH and LMWH) for potential 
      harms.Subgroup analyses were planned to examine gestational age, birth weight, 
      mode of thrombus diagnosis, presence of a central line, positive family history 
      for genetic disorders (thrombophilia, deficiency of protein S and protein C, 
      methylenetetrahydrofolate reductase [MTHFR] mutation), route of heparin 
      administration, type of heparin used, and location of thrombus (see "Subgroup 
      analysis and investigation of heterogeneity"). SEARCH METHODS: We used the 
      standard search strategy of the Cochrane Neonatal Review Group to search the 
      Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 4), MEDLINE 
      via PubMed (1966 to May 9, 2016), Embase (1980 to May 9, 2016), and the 
      Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to May 9, 
      2016). We searched clinical trials databases, conference proceedings, and the 
      reference lists of retrieved articles for randomized controlled trials and 
      quasi-randomized trials. SELECTION CRITERIA: Randomized, quasi-randomized, and 
      cluster-randomized controlled trials comparing heparin versus placebo or no 
      treatment in preterm and term neonates with a diagnosis of thrombosis. DATA 
      COLLECTION AND ANALYSIS: We used the standard methods of the Cochrane Neonatal 
      Review Group. Two review authors independently assessed studies identified by the 
      search strategy for inclusion. MAIN RESULTS: Our search strategy yielded 1160 
      references. Two review authors independently assessed all references for 
      inclusion. We found no completed studies and no ongoing trials for inclusion. 
      AUTHORS' CONCLUSIONS: We found no studies that met our inclusion criteria and no 
      evidence from randomized controlled trials to recommend or refute the use of 
      heparin for treatment of neonates with thrombosis.
FAU - Romantsik, Olga
AU  - Romantsik O
AD  - Department of Paediatrics, Lund University, Skane University Hospital, Lund, 
      Sweden.
FAU - Bruschettini, Matteo
AU  - Bruschettini M
FAU - Zappettini, Simona
AU  - Zappettini S
FAU - Ramenghi, Luca Antonio
AU  - Ramenghi LA
FAU - Calevo, Maria Grazia
AU  - Calevo MG
LA  - eng
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20161107
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - doi: 10.1002/14651858.CD012185
MH  - Anticoagulants/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Infant, Newborn
MH  - Thrombosis/*drug therapy
PMC - PMC6464761
COIS- All review authors declare that they have no competing financial conflicts of 
      interest.
EDAT- 2016/11/08 06:00
MHDA- 2016/12/22 06:00
PMCR- 2017/11/07
CRDT- 2016/11/08 06:00
PHST- 2016/11/08 06:00 [pubmed]
PHST- 2016/12/22 06:00 [medline]
PHST- 2016/11/08 06:00 [entrez]
PHST- 2017/11/07 00:00 [pmc-release]
AID - CD012185.pub2 [pii]
AID - 10.1002/14651858.CD012185.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2016 Nov 7;11(11):CD012185. doi: 
      10.1002/14651858.CD012185.pub2.