New anticoagulants: A pediatric perspective

Unfractionated heparin and vitamin K antagonists such as warfarin have been used as the anticoagulants of choice for over five decades. Subsequently, low molecular weight heparins (LMWHs) became widely available and have provided several advantages, especially in infants and children. The field of anticoagulation, however, has undergone a major revolution with better understanding of the structure of coagulation proteins and the development of a host of new drugs with highly specific actions. Many of these drugs have undergone extensive clinical testing in adults and have been approved for specific indications in adults. Unfortunately, clinical data and the reported use of these drugs in children are extremely limited. A lack of familiarity with the actions and pharmacokinetic properties of these drugs could be a major contributing factor. This review focuses on several of the new anticoagulants, with a special emphasis on those that could be potentially beneficial in pediatric patients with thromboembolic disorders. The need for well-designed trials with large-scale participation by pediatric hematologists in order to improve the antithrombotic care of young infants and children is also emphasized.