Oral anticoagulation in paediatric patients: dose requirements and complications

The lack of oral anticoagulant guidelines specific to paediatric practice has led to the adoption of adult regimens, often without scientific evidence of efficacy or safety. A two year prospective study of anticoagulant control was carried out in 45 children aged 9 months to 18 years, the majority o...

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Bibliographic Details
Published in:Archives of disease in childhood 1996-03, Vol.74 (3), p.228-231
Main Authors: Tait, R C, Ladusans, E J, El-Metaal, M, Patel, R G, Will, A M
Format: Article
Language:English
Subjects:
Adolescent
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Body Weight
Cardiovascular diseases
Child
Child, Preschool
Drug Administration Schedule
Female
Follow-Up Studies
Heart Defects, Congenital - surgery
Heart Valve Prosthesis
Humans
Infant
Male
Middle Aged
Prospective Studies
Thromboembolism - prevention & control
Warfarin - administration & dosage
Warfarin - adverse effects
Warfarin - therapeutic use
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Summary:The lack of oral anticoagulant guidelines specific to paediatric practice has led to the adoption of adult regimens, often without scientific evidence of efficacy or safety. A two year prospective study of anticoagulant control was carried out in 45 children aged 9 months to 18 years, the majority of whom were receiving primary prophylactic anticoagulation. The main indication was congenital heart disease, either with (n = 8) or without (n = 34) mechanical valve prosthesis. During a follow up period of 602 patient months the average interval between visits was three weeks. Target international normalised ratios (INRs) were achieved on 62% and 39% of visits for children with low target INR (2.0-3.0) and high target INR (3.0-4.0) respectively. However warfarin dose was altered on only 22% of visits. Warfarin doses required to achieve a stable INR of 2.0-3.0 in 33 children were strongly correlated with weight [dose (mg/d) = 0.07 x weight (kg) + 0.54] but independently influenced by age. No thrombotic complications were recorded, and haemorrhagic events were infrequent (2.1% of visits) and, with one exception, minor. Safe outpatient oral anticoagulation is feasible in children, whose warfarin requirements appear moderately predictable and whose control is no more erratic than that of adults.
ISSN:0003-9888
1468-2044
DOI:10.1136/adc.74.3.228