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Semin Thromb Hemost 2025; 51(07): 776-787
DOI: 10.1055/a-2546-0126
Review Article

Anticoagulants in Children with Renal Impairment: A Narrative Review

Autor*innen

  • Amy L. Kiskaddon

    1   Division of Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    2   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    3   Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, Florida
    4   Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
    5   Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

  • Daniel M. Witt

    6   Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah

  • Marisol Betensky

    2   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    7   Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

  • Anthony A. Sochet

    8   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    9   Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

  • Amanda Memken

    4   Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

  • Christoph Male

    10   Department of Pediatrics, Medical University of Vienna, Vienna, Austria

  • Neil A. Goldenberg

    2   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
    3   Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, Florida
    7   Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
    11   Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Venous thromboembolism is a common cause of morbidity and mortality in children with renal disease. To properly treat and prevent thromboembolism in this patient population, it is important to be familiar with the multitude of anticoagulant agents currently available. Many anticoagulant drugs undergo some extent of renal elimination. There are important considerations for the selection, dosing, and monitoring of anticoagulant drugs for patients with renal impairment due to various pharmacokinetic alterations that may occur. While there are data to help guide dosing and monitoring in adults, evidence regarding renal dose adjustment of many anticoagulant drugs in children are limited. For the clinician, anticoagulation management in children with renal impairment presents unique challenges. In addition to considering overall bleeding risk, the extent of renal impairment may vary by patient, making a one-size-fits-all approach to managing these patients difficult. These factors, combined with limited data, can make managing anticoagulation in children with renal impairment a challenge. Therefore, the focus of this review will be to describe the pharmacokinetics of the following anticoagulants in children with impaired renal function: unfractionated heparin, enoxaparin, dalteparin, rivaroxaban, apixaban, edoxaban, fondaparinux, bivalirudin, argatroban, dabigatran, and warfarin.

Keywords

anticoagulants - pediatric - renal impairment

Supplementary Material



Publikationsverlauf

Eingereicht: 31. Dezember 2024

Angenommen: 24. Februar 2025

Artikel online veröffentlicht:
28. März 2025

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