Journal
PEDIATRIC BLOOD & CANCER
Volume 53, Issue 3, Pages 468-471Publisher
WILEY
DOI: 10.1002/pbc.22067
Keywords
children; direct thrombin inhibitor; fondaparinux; heparin induced thrombocytopenia; warfarin
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Funding
- American Lebanese Syrian Associated Charities (ALSAC)
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An 11-year-old female developed heparin induced thrombocytopenia (HIT) with thrombosis during therapy for lower extremity deep vein thrombosis and pulmonary embolism. Transition from bivalirudin, a direct thrombin inhibitor (DTI), to warfarin resulted in extensive re-thrombosis, and fondaparinux therapy similarly failed. She was then treated with argatroban, and transitioned Successfully to warfarin after 9 weeks. The risk of re-thrombosis was ultimately reduced by allowing time for the thrombogenic potential to abate. The argatroban/warfarin transition was monitored with chromogenic factor X levels. This case highlights several difficult problems in pediatric thrombosis. Pediatr Blood Cancer 2009;53: 468-471. (C) 2009 Wiley-Liss, Inc.
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