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Direct thrombin and factor Xa inhibitors in children: a quest for new anticoagulants for children

Direkte Thrombin- und Faktor-Xa-Inhibitoren: eine Suche nach neuen Antikoagulanzien für Kinder

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Zusammenfassung

Venöse Thromboembolien (VTE) und Pulmonalembolien können auch Kinder betreffen und sind mit einer erheblichen Morbidität und Mortalität assoziiert. VTE betreffen zumeist Kinder mit schwerwiegenden zugrundeliegenden Erkrankungen und mehreren Risikofaktoren. Kinder im ersten Lebensmonat und in der Pubertät haben das höchste Risiko. Unfraktionierte und niedermolekulare Heparine sowie Vitamin-K-Antagonisten werden routinemäßig zur Prophylaxe und Behandlung der VTE eingesetzt. Die neuen sowohl parenteralen Antikoagulantien, wie Argatroban, Bivalirudin und Fondaparinux, als auch oralen Antikoagulantien, wie Dabigatran und Rivaroxaban, hätten günstige pharmakologische Eigenschaften; alle sind für die Verwendung im Erwachsenenalter zugelassen. Derzeit ist aber nur Argatroban für den Einsatz bei Kindern zugelassen. Die Bedeutung und der Wert dieser neuen Antikoagulantien für Kinder muss erst geklärt werden. Der Artikel beschäftigt sich mit den charakteristischen Besonderheiten der VTE bei Kindern und fasst die aktuelle Literatur über den Einsatz der neuen Thrombin- und Faktor-Xa-Inhibitoren in dieser Population zusammen.

Summary

Venous thrombosis and pulmonary embolism rarely occur in children but are associated with significant morbidity and mortality. Venous thromboembolism (VTE) mostly affects children with severe underlying conditions and multiple risk factors. Newborns and adolescents are at the highest risk. Standard and low molecular weight heparins and vitamin K antagonists are routinely used for the prevention and treatment of VTE. The new anticoagulants, both parenteral such as argatroban, bivalirudin and fondaparinux and oral such as dabigatran and rivaroxaban, have favourable pharmacological properties, all are approved for clinical use in adults and are currently being investigated in children. Argatroban is the only new anticoagulant licensed for use in children so far. The role of these new anticoagulants as alternative anticoagulants for children remains to be defined. This review focuses on the characteristics of VTE in children and reviews current knowledge on the use of the new thrombin and factor Xa inhibitors in this population.

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Authors and Affiliations

  1. Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria

    Werner Streif

  2. Research Center for Thromboembolic Disorders and Antithrombotic Therapies, Department of Clinical Medicine, University of Insubria, Varese, Italy

    Walter Ageno

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  1. Werner Streif
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  2. Walter Ageno
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Correspondence to Werner Streif.

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Streif, W., Ageno, W. Direct thrombin and factor Xa inhibitors in children: a quest for new anticoagulants for children. Wien Med Wochenschr 161, 73–79 (2011). https://doi.org/10.1007/s10354-011-0879-5

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  • DOI: https://doi.org/10.1007/s10354-011-0879-5

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