🩸 Section 528.1 · Anticoagulant and Thrombolytic Therapy

Nelson Textbook of Pediatrics 22nd Edition | Pediatric anticoagulation: Unfractionated heparin (UFH, PTT 1.5-2.5x baseline), Low molecular weight heparin (LMWH, enoxaparin, anti-Xa 0.5-1 U/mL), warfarin (INR 2-3 for VTE), direct oral anticoagulants (DOACs: rivaroxaban, dabigatran). Thrombolysis (tPA) for life/limb-threatening thrombosis. Reversal agents: protamine (heparin), vitamin K/PCC (warfarin), idarucizumab (dabigatran), andexanet alfa (factor Xa inhibitors).

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📋 30 Clinical Scenarios — Anticoagulant & Thrombolytic Therapy

📇 High‑Yield Review Cards (Anticoagulation)

🩺 Clinical Scenarios: Anticoagulant Therapy

Select a presentation for anticoagulation guidance.

📋 Stepwise Management of Anticoagulant & Thrombolytic Therapy

🔑 Key Principles — Nelson Section 528.1
• UFH (Unfractionated heparin): Initial bolus 75-100 U/kg, then infusion 20-25 U/kg/hr (neonates higher). Monitor PTT (target 1.5-2.5x baseline) or anti-Xa (0.35-0.7 U/mL). Reversal: protamine 1 mg per 100 U heparin.
• LMWH (Enoxaparin): Neonates: 1.5 mg/kg q12h; children ≥2 months: 1 mg/kg q12h. Anti-Xa goal 0.5-1 U/mL (drawn 4h after dose). Reversal: protamine (partial).
• Warfarin: Overlap with LMWH 5-7 days. INR goal 2-3 (VTE) or 2.5-3.5 (mechanical valves). Reversal: vitamin K (oral/IV), 4-factor PCC for life-threatening bleeding.
• DOACs: Rivaroxaban (factor Xa inhibitor), dabigatran (direct thrombin inhibitor). Fixed dosing based on age/weight. No routine monitoring. Reversal: andexanet alfa (Xa inhibitors), idarucizumab (dabigatran).
• Thrombolysis (tPA): For life/limb-threatening thrombosis (massive PE, phlegmasia, acute limb ischemia). Dose: 0.1-0.5 mg/kg/hr (prolonged infusion). Monitor fibrinogen (>100 mg/dL), platelets.

    ⚡ Reflex Prompts — Clinical Decisions in Anticoagulation

    📖 Summary: Anticoagulant & Thrombolytic Therapy — Nelson 528.1