Anticoagulation and antiaggregation in pediatrics

Abstract

The hemostatic system consisting of primary and secondary hemostasis as well as fibrinolysis is an evolving process throughout life with important qualitative and quantitative differences between children and adults. Moreover, the different age groups of childhood differ in many aspects of their hemostatic system. These differences reflect an adaptation to the young age rather than immaturity. Knowledge of the pediatric characteristics of the hemostatic system is the basis to diagnose, prevent and treat thromboembolic disorders. The achievements in intensive care medicine caused a higher incidence of thromboembolic events and, together with an increased knowledge of the pathophysiology, promoted hemostaseology as a pediatric subspecialty. The management of thromboembolic events with anticoagulants and platelet function inhibitors was first established in adult patients and many evidence based guidelines are achieved. However, clinical trials in children are rare due to the less developed network of the young pediatric subspecialty, and to the need of international cooperation because of small patient numbers. Based on this, experience made in adults is often extrapolated to similar situations in childhood neglecting the differences of the pediatric aspects of the hemostatic system, but also simply neglecting the child as a patient. The management of children with defects of the hemostatic system is therefore characterized by controversies that are further fueled by a lack of data. There is, however, a beginning of international activities with clinical trials and attempts of developing evidence based guidelines, or guidelines clearly stating where evidence is lacking. This activity should be supported by the international community of pediatricians who promote progress in knowledge and management of pediatric hemostatic system disorders.