Anticoagulation

The coagulation system is a physiologic response to vessel injury to minimize blood losses by promotion of thrombus formation. Particularly in the venous vasculature, hemostasis is heavily influenced by stasis of blood flow, by local inflammatory response to the vessel wall to the injury, and by varying degrees of hypercoagulability states dependent on systemic vs local and/or disease vs therapy-induced factors. PediatricPediatric patients undergoing or who have undergone cardiac interventions/surgeries are at high risk for thrombosis with venous thrombotic eventsThrombotic event in 19–40% of patients. Up to 28% of these are serious events. The identified risk factors for thrombotic eventsThrombotic event (TE) include mechanical valves, BTT shunts, and patients with single ventricleSingle ventricle palliation physiology. AntiplateletAntiplatelet and anticoagulant agents act by inhibiting different steps of the formation of the platelet plug or the insoluble thrombus. Classes of agents include anticoagulants (unfractionated and low molecular weight heparinHeparin), oral vitamin K antagonists (warfarin), direct oral anticoagulants (DOACsDOAC), and antiplateletAntiplatelet agents (ASA, thienopyridines). The most common prophylactic and treatment algorithms are summarized in this chapter.