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Clinical Pharmacokinetics

, Volume 52, Issue 11, pp 967–980 | Cite as

Pharmacokinetics and Pharmacodynamics of Anticoagulants in Paediatric Patients

  • Donald L. Yee
  • Sarah H. O’Brien
  • Guy Young
Review Article

Abstract

Given the rising incidence of thrombotic complications in paediatric patients, understanding of the pharmacologic behaviour of anticoagulant drugs in children has gained importance. Significant developmental differences between children and adults in the haemostatic system and pharmacologic parameters for individual drugs highlight potentially unique aspects of anticoagulant pharmacology in this special and vulnerable population. This review focuses on pharmacologic information relevant to the dosing of unfractionated heparin, low molecular weight heparin, warfarin, bivalirudin, argatroban and fondaparinux in paediatric patients. The bulk of clinical experience with paediatric anticoagulation rests with the first three of these agents, each of which requires higher bodyweight-based dosing for the youngest patients, compared with adults, in order to achieve comparable pharmacodynamic effects, likely related to an inverse correlation between age and bodyweight-normalized clearance of these drugs. Whether extrapolation of therapeutic ranges targeted for adult patients prescribed these agents is valid for children, however, is unknown and a high priority for future research. Novel oral anticoagulants, such as dabigatran, rivaroxaban and apixaban, hold promise for future use in paediatrics but require further pharmacologic study in infants, children and adolescents.

Keywords

Warfarin International Normalize Ratio Enoxaparin Rivaroxaban Apixaban 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors thank Linda DeMuro, MLS, and Susi Miller, MLIS, AHIP, from the Grant Morrow III, MD Medical Library at Nationwide Children’s Hospital (Columbus, OH, USA) for their assistance in designing the search strategy and performing the initial literature search. Drs Yee and Young have no financial conflicts of interest to disclose. Dr O’Brien is a member of a Bristol-Myers Squibb advisory board for paediatric apixaban studies.

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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Donald L. Yee
    • 1
  • Sarah H. O’Brien
    • 2
  • Guy Young
    • 3
  1. 1.Texas Children’s Hospital, Baylor College of MedicineHoustonUSA
  2. 2.Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children’s HospitalColumbusUSA
  3. 3.Children’s Hospital Los AngelesUniversity of Southern California Keck School of MedicineLos AngelesUSA

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