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.

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.