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Trends in parenteral direct thrombin inhibitor use in pediatric patients: analysis of a large administrative database.
[heparin-induced thrombocytopenia]
Parenteral
direct
thrombin
inhibitors
(
DTIs
)
may
be
used
in
pediatric
patients
with
contraindications
to
heparin
therapy
,
such
as
heparin-induced
thrombocytopenia
.
Few
data
exist
regarding
the
use
of
DTIs
in
pediatric
patients
.
To
characterize
the
use
of
DTIs
in
pediatric
patients
,
including
monitoring
strategies
and
bleeding
complications
.
A
retrospective
descriptive
study
was
designed
and
the
Pediatric
Health
Information
System
database
was
queried
from
2004
to
2011
for
pediatric
patients
receiving
a
parenteral
DTI
.
Patient
demographic
and
hospital
data
,
mortality
,
disease
state
,
and
procedure
information
(
from
International
Classification
of
Diseases
,
Ninth
Revision
codes
)
were
collected
from
the
query
.
DTI
monitoring
information
was
also
collected
.
Patients
were
divided
into
2
time
periods
(
2004
-
2007
,
2008
-
2011
)
to
evaluate
trends
.
Two
hundred
eight
patients
met
study
criteria
(
50
.
9
%
male
,
64
.
4
%
white
)
,
and
children
(
2
-
12
years
of
age
)
represented
34
.
6
%
of
the
population
.
Congenital
heart
disease
was
present
in
43
.
8
%
and
cardiovascular
surgical
procedure
occurred
in
28
.
4
%
.
Argatroban
was
most
commonly
used
(
73
.
1
%
)
and
bivalirudin
use
increased
(
P
<
.
001
)
.
Bleeding
complications
were
present
in
37
.
9
%
of
patients
and
mortality
was
19
.
7
%
.
Bleeding
complications
were
associated
with
lepirudin
(
62
.
5
%
)
and
argatroban
(
41
.
7
%
)
more
often
as
compared
with
bivalirudin
(
18
.
8
%
)
(
P
<
.
001
)
.
Activated
partial
thromboplastin
time
and
prothrombin
time
were
used
more
often
in
patients
receiving
argatroban
and
lepirudin
in
comparison
with
bivalirudin
,
and
thrombin
time
was
used
more
often
in
patients
receiving
lepirudin
(
P
<
.
001
)
.
Activated
clotting
time
use
increased
over
time
(
5
.
1
%
versus
17
.
5
%
,
P
=
.
02
)
.
Pediatric
use
of
DTIs
is
infrequent
and
occurs
in
patients
with
high
morbidity
and
mortality
.
Diseases
Validation
Diseases presenting
"heart disease"
symptom
22q11.2 deletion syndrome
achondroplasia
acute rheumatic fever
adrenal incidentaloma
child syndrome
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
dentinogenesis imperfecta
esophageal adenocarcinoma
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kabuki syndrome
monosomy 21
omenn syndrome
phenylketonuria
sneddon syndrome
systemic capillary leak syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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