Oral anticoagulation in paediatric patients: dose requirements and complications

• 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
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.74.3.228

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.