New anticoagulants in children: A review of recent studies and a look to the future

Thromboembolic complications are increasing in children and the use of anticoagulation has seen a dramatic increase. The most widely used agents in children, heparin, low molecular weight heparin, and warfarin all have limitations which are exaggerated in children. This has led to the study of newer agents with improved pharmacologic properties such as bivalirudin, argatroban, and fondaparinux. In addition, clinical trials are under way to assess several new oral anticoagulants that are in late phase studies or already licensed in adults. Based on the completed studies in children, several recommendations for the use of currently available agents (bivalirudin, argatroban, and fondaparinux) are suggested for clinical use today. Additional studies need to be conducted for the above agents which will lead to their expanded use in selected indications. Furthermore, new regulatory requirements are leading to a number of studies in the newer anticoagulants that are yet to be licensed in adults for treatment of venous thromboembolism. Pediatric thrombosis is entering a fruitful era of research in the area of anticoagulation management which is sure to lead to significant changes in how children are treated in the next 10 years.