Background: Heparin induced thrombocytopenia (HIT) is a potentially life threatening adverse effect of heparin therapy. Marked by thrombocytopenia and associated with thrombosis in up to 50% of cases of all ages.
HIT is very rare in children in comparison to adults.
HIT is currently treated with heparinoids, followed by conversion to oral warfarin upon platelet recovery.
Methods: We report the experience of our tertiary center: a series of 3 children who were diagnosed with HIT following Heparin or LMWH treatment, who were treated direct thrombin inhibitor (Bivalirudin) as primary treatment of HIT.
Results: the children treated were 2 males and 1 female age 4, 10 and 18 years old. Thrombotic manifestations included: 2 children with sinus vein thrombosis, 1 child with Leukemia and atrial thrombus. All were treated with Bivalirudin for 5 to 14 days.
Case 1 who was diagnosed with sinus vein thrombosis needed craniectomy due to elevated ICP. During the treatment period. He was treated with bivalirudin for 14 days.
Case 2, who was diagnosed with sinus vein thrombosis, needed also ffp and plasmapheresis during the treatment. She was treated with bivalirudin for 10 days. She was discharged to her home with continuous fondaparinaux and concomitant warfarin treatment.
Case 3 who was diagnosed with leukemia and lt atrial central catheter thrombus was treated with bivalirudin for 5 days the catheter was removed the child continued treatment with fondaparinux due the cancer treatment till the meintenance period of the treatment treatment and than was changed to warfarin.
All cases were treated with bivalirudin for 7-14. They were discharge from the intensive care unit and continue treatment with warfarin or fondaprinux which was changed later to warfarin.
Discussion: Pediatric HIT following Heparin or LMWH is a rare condition.
Understanding of the pathogenesis, risk factors and available therapy, may improve the outcome of those patients.
