Use of anticoagulants in children: a cross-sectional study at Albert Royer Children Hospital and Cardio-Pediatric Surgery Center of Fann University hospital in Dakar, Senegal

Résumé fourni par la source

Introduction: the use of anticoagulants in children is less frequent and requires more precautions (higher doses, unsuitable formulations, risk of treatment-related complications). We aimed to describe the challenge of using anticoagulants in children in a sub-Saharan hospital. Methods: we conducted a cross-sectional study at the Albert Royer National Children's Center and the Cardio-Pediatric Surgery Center of Fann University Hospital, with a prospective recruitment over a 6-month period. All patients aged 0 to 15 years who had received anticoagulant treatment and biological monitoring were included. Results: thirty-one patients were included. The mean age was 13 years (extremes: 13 days and 15 years) with 58.1% of girls (N=18). Among the causes of thrombotic events requiring anticoagulation, cardiac diseases were the most common in 80.6% (N=25), followed by tumor, autoimmune and traumatic causes at equal proportions of 3% (N=1). Treatment was preventive in 61.2% (N=19) of cases and curative in 38.8% (N=12). The most commonly used anticoagulant was vitamin K antagonist (VKA) in 70.9% of cases (N=22); followed by low molecular weight heparin (LMWH) in 61.29% (N=19); then unfractionated heparin (UFH) in 45.1% (N=14). One patient received rivaroxaban. All patients who received LMWH were treated with 200 IU/kg/day. The median dose of UFH was 8.3 IU/kg/h. For patients receiving VKA; 52.9% (N=9) had a dosage less than 0.1mg/kg/day. In 63.2% (N=12) of cases, the switch molecule was VKA. The median time to achieve the target INR was 13.5 days. Complications occurred in 9 patients (29.03%): heparin-induced thrombocytopenia (N=2), vitamin K antagonist overdose (N=6) and epistaxis (N=1). Conclusion: this study shows, on the one hand, that children are mostly under-dosed with anticoagulants; on the other hand, when the effective dose is reached, nearly one-third of anticoagulation-related accidents occur in this population.

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