Treatment of Deep Vein Thrombosis with Continuous I.V. Infusion of LMWH in Children Safe and Efficient Alternative to S.C. Application

Incidence of the thrombosis is age dependent with the lowest risk is in the childhood. Children mostly suffer from vein thrombosis (DVT/ PE). Occurrence of thrombosis in children is 0,07/ 10 000, among hospitalized children is higher 3,5/ 10 000. In comparison with adults, these numbers are very low. LMWH is preferred in the treatment of DVT in children. UFH is used as second choice medication. LMWH is widely used in prevention of recurrence of DVT and sometimes it substitutes (especially in very young children) vitamin K antagonists. The most frequent form of application of LMWH is via subcutaneous injection. A few articles can be found in literature about treatment by intravenous continuous infusion in infants and in several cases in older children. The treatment by continuous infusion has certain advantages, especially for hospitalized patient with permanent i.v. access (painless, shorter half-life consecutively lower risk of bleeding, easier control). We present group of 27 children with DVT, who were treated with LMWH for first thrombosis from 2003 till 2005. We did the screening of thrombophilia in all of those children. We found FVleiden heterozygous in 38,1%, FII G2021OA heterozygous in 4,76, inherited deficiency of AT in 14,29%, BCP in 9,52 % and CVL was inserted in 52,38% of our patients.All patients had at least one of the risk factors of thrombophilia. We started to treat all patients with LMWH and the dose was adjusted to reach the level of antiXa between 0,5-1 IU/ml. We treated 6 patients (22,22%) by subcutaneous injection (average LMWH dose 215,54IU/kg/d) and 21 patients (77,78%) by continuous infusion (average dose 254,94IU/kg/d). Duration of the treatment was modified in accordance with the course of thrombosis (monitored by Doppler ultrasound with compression), but it went on for at least 7 days and was followed by the prophylaxis with LMWH or vitamin K antagonists. The treatment with LMWH (both i.v. or s.c.) lead to recanalisation of the vein in 26 cases (96,29%), 58% of them without any residue or mural thrombosis. We did not notice any bleeding as adverse event of the treatment in our patients.We would like to point out that treatment of DVT with continuous infusion of LMWH in children might be efficient and safe alternative of to s.c. application in certain circumstances. When administered by continuous infusion, LMWH has shorter half-life and it could be useful especially in hospitalized children and in children who are endangered by risk of bleeding complications.