Published online February 16, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e510-e518 (doi:10.1542/peds.2008-2052)
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REVIEW ARTICLE

Unfractionated Heparin Therapy in Infants and Children

Fiona Newall, MN, BSci, RNa,b,c,d, Linda Johnston, PhD, BSci, RNb,c,d,e, Vera Ignjatovic, PhD, BScia,c,d and Paul Monagle, MD, MSci, MBBS, FRACP, FRCPAa,c,d

a Department of Pathology
b School of Nursing and Social Work, University of Melbourne, Melbourne, Australia
d Murdoch Childrens Research Institute
c Clinical Haematology
e Department of Neonatology, Royal Children's Hospital, Parkville, Australia

Unfractionated heparin is frequently used in tertiary pediatric centers for the prophylaxis and treatment of thromboembolic disease. Recent evidence suggests that the clinical outcomes of unfractionated heparin therapy in children are poor, as determined by target-range achievement and adverse-event rates. These reports of poor outcomes may be related to an age-dependent mechanism of action of unfractionated heparin. Furthermore, several published studies have indicated that unfractionated heparin–monitoring assays currently in clinical use have significant limitations that likely affect the safety and efficacy of anticoagulant management. This review summarizes the growing body of evidence suggesting that pediatric-specific recommendations for unfractionated heparin therapy management are required to improve clinical outcomes related to this commonly prescribed medication.

Key Words: unfractionated heparin • anticoagulation • drug safety • hematology • laboratory medicine

Abbreviations: UFH—unfractionated heparin • ACCP—American College of Chest Physicians • APTT—activated partial thromboplastin time • VTE—venous thromboembolism • VKA—vitamin K antagonist • LMWH—low molecular weight heparin • TFPI—tissue factor pathway inhibitor • anti-IIa—anti–factor IIa • anti-Xa—anti–factor Xa • TCT—thrombin clotting time • HIT II—heparin-induced thrombocytopenia II • SRA—serotonin-release assay

Accepted Nov 25, 2008.


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