Efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome

Thrombosis Research, 08/24/2012

Seltz LB et al. – Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.

Methods

  • The authors performed a retrospective chart review of all children (≤18years) hospitalized with diarrhea associated hemolytic uremic syndrome.
  • Outcomes in clopidogrel treated children were described.
  • In subgroup analysis, outcomes were compared to those untreated with platelet aggregation inhibitors.

Results

  • Of 72 children with diarrhea associated hemolytic uremic syndrome, 88% were treated with platelet aggregation inhibitors (clopidogrel 56%, sulfinpyrazone 19%, dipyridamole 13%).
  • The median age of clopidogrel treated children was 5years; 40% were male.
  • Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53×103/ μL, and 2.3mg/dL respectively.
  • Clopidogrel (median dose 1mg/kg/d) was given for a median of 4days (range 1–15).
  • Other therapies included erythropoietin (98%), red blood cell transfusions (80%), diuretics (58%), anti–hypertensive agents (45%), and dialysis (33%).
  • The median hospital length of stay was 9days (range 3–26).
  • Three children had bleeding complications (epistaxis/hematemesis).
  • The risk of chronic kidney disease was 5% and death 2.5%.
  • In subgroup analysis, median duration of dialysis was 11days in thirteen clopidogrel treated children compared to 21days in five untreated patients (P=0.04).

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