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Blood, Vol. 94 No. 9 (November 1), 1999:
pp. 3007-3014
Analysis of Warfarin Therapy in Pediatric Patients: A Prospective
Cohort Study of 319 Patients
W. Streif,
M. Andrew,
V. Marzinotto,
P. Massicotte,
A.K.C. Chan,
J.A. Julian, and
L. Mitchell
From the Hamilton Civic Hospital Research Centre,
Hamilton, Ontario; the Hospital for Sick Children, Toronto; and
McMaster University, Hamilton, Ontario, Canada.
This study details warfarin use in a large pediatric
population followed in a central anticoagulation clinic. A prospective, consecutive cohort of nonselected children were studied.
Patients were divided into groups by age, target international
normalized ratio (INR) range, disease, medications, and vitamin K
supplemented enteral nutrition use. Groups were analyzed on multiple
aspects of warfarin therapy using multivariate methods. A total of 319 patients received 352 warfarin courses representing 391 treatment years. Age independently influenced all aspects of therapy. When compared with all older children, the  1 year of age group required increased warfarin doses, longer overlap with heparin, longer time to
achieve target INR ranges, more frequent INR testing and dose
adjustments, and fewer INR values in the target range. Although significantly different than children 1 year, children 1 to 6 years
of age showed the same findings when compared with 7- to 18-year-olds.
Fontan patients required 25% decreased dosage as compared with other
congenital heart disease patients. Children on corticosteroids had
less INRs in the target range and children on
phenobarbital/carbamazepine required increased maintenance dosages of
warfarin. Also, patients receiving enteral nutrition required increased
dosages of warfarin. Serious bleeding occurred in 2 children (0.5% per
patient year). Recurrent thromboembolic events (TEs) occurred in 8 children. Two children had recurrences while receiving warfarin (1.3%
per patient year). This study outlines the profound effect of age and
relative complexity of clinical management of warfarin therapy in children.
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