Dosing for antithrombotic therapy in children
. | Loading dose, U/kg . | Initial maintenance dose . | Monitoring . |
|---|---|---|---|
| Unfractionated heparin by continuous IV4,24 | |||
| Neonates less than 28 wk gestation | 25 | 15 U/kg/h (may require ≥ 20 U/kg/h to achieve therapeutic anti-Xa level | Anti-Xa activity: 0.3-0.7 U/mL |
| Neonates 28-37 wk gestation | 50 | 15 U/kg/h(may require ≥ 25 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Infants at least 37 wk gestation | 100 | 28 U/kg/h (may need ≥ 50 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Infants and children older than 1 mo | 75 | 20 U/kg/h (may need ≥ 30 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Low-molecular-weight heparin30 and subcutaneous enoxaparin, q12h | |||
| Newborns under 1 mo old | None | 1.625 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Infants 1 mo to less than 1 y old | None | 1.5 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Children 1 y to less than 6 y old | None | 1.375 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Children 6 y to less than 21 y old | None | 1.25 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Tissue plasminogen activator by continuous23 IV or bolus* | |||
| Infants less than 3 mo old | None | 0.06 mg/kg/h | Clot lysis by imaging or decrease in extent; increase in D-dimer or FSP level |
| Children 3 mo to less than 21 y old | None | 0.03 mg/kg/h; max 2 mg/h | Clot lysis by imaging or decrease in extent; increase in D-dimer or FSP level |
. | Loading dose, U/kg . | Initial maintenance dose . | Monitoring . |
|---|---|---|---|
| Unfractionated heparin by continuous IV4,24 | |||
| Neonates less than 28 wk gestation | 25 | 15 U/kg/h (may require ≥ 20 U/kg/h to achieve therapeutic anti-Xa level | Anti-Xa activity: 0.3-0.7 U/mL |
| Neonates 28-37 wk gestation | 50 | 15 U/kg/h(may require ≥ 25 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Infants at least 37 wk gestation | 100 | 28 U/kg/h (may need ≥ 50 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Infants and children older than 1 mo | 75 | 20 U/kg/h (may need ≥ 30 U/kg/h to achieve therapeutic anti-Xa level) | Anti-Xa activity 0.3-0.7 U/mL |
| Low-molecular-weight heparin30 and subcutaneous enoxaparin, q12h | |||
| Newborns under 1 mo old | None | 1.625 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Infants 1 mo to less than 1 y old | None | 1.5 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Children 1 y to less than 6 y old | None | 1.375 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Children 6 y to less than 21 y old | None | 1.25 mg/kg | Anti-Xa activity 0.5-1.0 U/mL |
| Tissue plasminogen activator by continuous23 IV or bolus* | |||
| Infants less than 3 mo old | None | 0.06 mg/kg/h | Clot lysis by imaging or decrease in extent; increase in D-dimer or FSP level |
| Children 3 mo to less than 21 y old | None | 0.03 mg/kg/h; max 2 mg/h | Clot lysis by imaging or decrease in extent; increase in D-dimer or FSP level |
Lower doses of TPA are used in interventional catheter-directed procedures; higher doses of TPA are used by others. See “Thrombolysis using tissue plasminogen activator” for dosing schedules. Bolus dosing of TPA (1 mg/kg with a maximum of 50 mg) can be used for massive PE