Table 8 Thromboembolic events: therapy and prophylaxis

Unfractionated heparin

Begin at the time of the acute event and continue for 5–10 days.

Suspend on day 6 after OAT start, if INR on target. (Grad 1C +).

Minor use in the last decade.

75 UI/kg bolus in10 min

Initial maintenance dose:

>1 year: 28 UI/Kg/h

>1 year. 20 UI/Kg/h

Then adjust to maintain aPTT between 60–85 s.

aPTT

Therapeutic target: between 60–85 s.

Low molecular weight heparin (LMWH)

More used in the last decade in the treatment of thromboembolism in children

Enoxaparin Dosage (>2 months)

Therapeutic: 100 UI/kg every 12 h

Prophylactic: 50 UI/ kg every 12 h

If clearance <60 ml/min) dosage must be adjusted on renal function

Anti Xa: blood samples 4 h after drug administration

Therapeutic target: 0.5.1 UI/mL

Prophylactic target: 0.3-0.5 UI/mL

Oral anticoagulants

(warfarin)

Begin with heparin therapy until the target INR(2–3) is reached.

Continue for 3 months, in absence of predisposing factors like NS.

Continue for 6 months in presence of predisposing factors, like NS, or in cases of recurrent thrombosis.

Vitamin K antagonists more used for older children (frequent blood check)

In pediatric patients > 10 Kg: 0.2 mk/Kg/day

(For dosage adjustment, see Chest 2012 [61] and Paediatr Drugs 2015 [63]

INR Target: 2-3

Aspirin

If PLT >1.000.000 /mmc with concomitant NS

Empirical antiplatelet dosage in pediatrics: 1–5 mg/kg/day

Fibrinolytic agents

No data on fibrinolytic treatment of thrombotic events in pediatric patients with NS.

Use only in selected cases (urokinase, tPA) according to published recommendations [60, 61]