CHEST Guidelines-Antithrombotic-Therapy-in-Neonates-and-Children

Antithrombotic-Therapy-in-Neonates-and-Children_ch

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The "Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: ACCP Guidelines" document details recommendations for managing thrombosis in neonates and children, emphasizing the differences from adult care. It highlights that due to unique physiological and pharmacological responses in children, pediatric hematologists should ideally manage these cases (Grade 2C recommendation). When such experts are unavailable, collaboration with neonatologists and adult hematologists is advised.<br /><br />For unfractionated heparin (UFH) therapy, the recommendation is to achieve anti-Xa activity within a specific range (Grade 2C). In cases where UFH therapy is initiated, boluses should be limited, especially when bleeding risk is high, and long-term UFH use should generally be avoided in children (Grade 2C).<br /><br />Low-molecular-weight heparin (LMWH) therapy in children should also be monitored to a specific anti-Xa range (Grade 2C). For vitamin K antagonists (VKAs) like warfarin, the guidelines suggest maintaining INR targets similar to adults but recognize the challenges of managing these in pediatric conditions due to dietary and drug interactions (Grade 2C).<br /><br />Regarding catheter-related thrombosis, it is advised that central venous access devices with confirmed thrombosis be removed after 3-5 days of anticoagulation. Anticoagulant therapy such as LMWH or UFH is recommended with a duration of 6 weeks to 3 months (Grade 2C).<br /><br />The guidelines emphasize individual assessment for interventions like thrombolysis and note the need for future studies to ascertain optimal therapeutic ranges and develop specific management strategies for thrombosis in children. Adverse effects, such as bleeding during therapy, require cautious monitoring and tailored solutions to mitigate risks.<br /><br />Overall, while the evidence for many recommendations remains weak, these guidelines aim to provide a standardized approach pending further research to refine antithrombotic management in neonatal and pediatric cases.

Keywords

antithrombotic therapy

thrombosis management

pediatric hematology

unfractionated heparin

low-molecular-weight heparin

vitamin K antagonists

catheter-related thrombosis

anticoagulant therapy

thrombolysis

pediatric guidelines