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Challenges and Opportunities in the Pharmacological Treatment of Acute Venous Thromboembolism in Children

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Abstract

Venous thromboembolism (VTE) is an important but historically under-recognized problem in pediatrics, with an incidence concentrated in hospitalized children. A number of specific VTE diseases with discrete triggers have been described, but the most common pediatric trigger is the presence of central venous access devices. VTE diseases, though heterogenous in etiology, are linked by the common therapeutic strategies shared by their management. Historically, the most commonly used drug therapies have been unfractionated heparin, low-molecular-weight heparins, and vitamin K antagonists, based on extrapolation from adult data rather than any specific pediatric trials. Although these widely used drugs appear safe and effective in expert hands, the historical lack of pediatric data is problematic in view of the recognized significant differences between children and adults with regards to hemostatic physiology, VTE etiology, and drug pharmacokinetics. The increasing adult usage of novel VTE pharmacotherapies such as direct oral anticoagulants (DOACs) has led to considerable interest in exploring the pediatric applications of these newer drugs. This review summarizes the advantages and disadvantages of existing VTE pharmacotherapies and outlines emerging novel pediatric VTE therapies, particularly DOACs, within the context of the current pediatric trial landscape.

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Authors and Affiliations

  1. Department of Clinical Haematology, The Royal Children’s Hospital, 50 Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia

    Carly George, Marzia Rahman & Paul Monagle

  2. Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia

    Paul Monagle

  3. Haematology Research Group, Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    Paul Monagle

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  1. Carly George
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  2. Marzia Rahman
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Correspondence to Paul Monagle.

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Carly George, Marzia Rahman and Paul Monagle declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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George, C., Rahman, M. & Monagle, P. Challenges and Opportunities in the Pharmacological Treatment of Acute Venous Thromboembolism in Children. Pediatr Drugs 22, 385–397 (2020). https://doi.org/10.1007/s40272-020-00403-5

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