Original ArticleClopidogrel Use in Children
Section snippets
Methods
A retrospective review of the inpatient pharmacy records was undertaken to identify children hospitalized at The Hospital for Sick Children, Toronto in whom prophylactic antiplatelet therapy with clopidogrel bisulfate (Plavix; Sanofi-Synthelabo/Bristol Myers Squibb, Canada) was administered between January 2001 and April 2004. The hospital ethics committee approved the study. Relevant clinical data were extracted from the children's hospital records, including age, sex, weight, underlying
Results
Fifteen infants and children treated with clopidogrel were identified (Table). The female to male ratio was 2:1, median age was 3.5 years (range, 6 weeks to 16 years), and mean weight was 15.0 ± 9.5 kg. Four of the 15 children were under age 1 year. Fourteen children underwent cardiac catheterization; their underlying cardiac conditions and indications for the procedure are summarized in Table. Endovascular stents were inserted in 10 children (71%). In these children, clopidogrel therapy was
Discussion
The pathophysiology of thrombosis in children with heart disease is a complex phenomenon. It may involve endothelial cell damage after surgery, stent insertion, indwelling catheterization, or endovascular procedures (eg, Fontan and Blalock-Taussig shunting).4 Abnormalities in blood flow patterns and polycythemia may also lead to hyperviscosity and stasis. Venous thrombus formation is usually the result of local coagulation activation combined with a disturbed balance between coagulation and
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2021, EJVES Vascular ForumCitation Excerpt :Platelet aggregation with aspirin at the standard prophylactic dose has been shown to be safe. Aspirin is the most commonly used platelet anti-aggregant in children with cardiovascular disease, although the use of clopidogrel is increasing.10 In this case, platelet anti-aggregation was started early with aspirin at a dose of 3 mg/kg/day for up to 100 mg/day, a dose that has been maintained until today.
What is the optimal dose of clopidogrel in pediatric patients?
2019, Anales de PediatriaEfficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome
2012, Thrombosis ResearchCitation Excerpt :The optimal dose of clopidogrel is uncertain. In studies of clopidogrel use in children, the mean daily dosing regimens varied between 0.41 mg/kg and 2.3 mg/kg with some patients receiving up to 8.9 mg/kg [15–18]. Clopidogrel dosing also varied in our study population (mean 0.85 mg/kg/day).
Kawasaki disease
2010, Paediatric CardiologyKawasaki Disease
2009, Paediatric CardiologySafety and Efficacy of Clopidogrel in Children with Heart Disease
2008, Journal of PediatricsCitation Excerpt :This is consistent with earlier in vitro results in which, compared with platelets from adults, platelets from young children were hyporesponsive to stimuli and exhibited decreased aggregation and granule secretion.5 Adult doses extrapolated to children on the basis of weight can be life-threatening and cause increased bleeding.9-10 The optimal clopidogrel dose in infants and children is being evaluated in the Platelet Aggregation Inhibition in Children On CLOpidogrel (PICOLO) trial.
Finkelstein is supported by a fellowship grant from The Hospital for Sick Children Research Training Center. Koren is a Senior Scientist of the Canadian Institute for Health Research and holder of the Ivey Chair in Molecular Toxicology, University of Western Ontario, London, Ontario.