肾功能不全儿童静脉血栓栓塞的抗凝治疗

Anticoagulant Therapy for Venous Thromboembolism in Children with Renal Insufficiency

关键词:  肾功能不全  儿童  静脉血栓栓塞症  抗凝药物

Key words:  Renal insufficiency  Children  Venous thromboembolism  Anticoagulant drugs

摘要:

目的 探讨肾功能不全的儿童治疗和预防静脉血栓栓塞症(Venous thromboembolism，VTE)的研究进展, 为临床应用提供参考。方法 以“肾功能不全”“儿童”“静脉血栓栓塞症”“抗凝药物”“Children”“renal insufficiency”“Venous thromboembolism”“Anticoagulant drugs”等为关键词，在中国知网、万方数据、PubMed等数据库中组合查询2015年9月-2025年9月发表的相关文献，归纳肾功能不全儿童VTE抗凝治疗的研究进展。结果：共检索到相关文献89篇，其中有效文献40篇。肾功能不全儿童血栓危险因素是独特的，抗凝治疗中除了注意肾功能不全的程度外，患儿本身以及疾病因素也可能影响抗凝药物的药动学和药效学。儿童可用的抗凝药物中普通肝素和阿加曲班肾功能不全无需调整剂量，但需要静脉给药，方便度低。皮下给药的低分子肝素中，依诺肝素儿童使用数据相对最充分，但给药需要结合患儿肾功能情况。口服药物华法林虽然肾功能不全无需调整剂量，但需要频繁的实验室监测以及相互作用较多。口服药物利伐沙班和达比加群儿童使用数据较充分，需要根据肾功能调整剂量，但两者均具备混悬液剂型，在提升儿童用药依从性方面具有相对优势。结论：每种抗凝药物在肾功能不全儿童中具有独特的特点和注意事项，在选择和调整剂量时需充分考虑患儿肾功能情况、药物特点和疾病因素，选择最适宜的抗凝方案。

Abstract:

Objective:To explore the research progress in the treatment and prevention of venous thromboembolism (VTE) in children with renal insufficiency, and to provide a reference for clinical practice. Methods: A comprehensive literature search was conducted in databases including CNKI, Wanfang Data, and PubMed using the keywords “renal insufficiency”, “children”, “venous thromboembolism”, “anticoagulant drugs” and their English equivalents. The search covered articles published from September 2015 to September 2025. The retrieved literature was systematically analyzed to summarize the research progress in anticoagulant therapy for VTE in children with renal insufficiency.Results: A total of 89 relevant articles were identified, among which 40 were eligible for inclusion. The risk factors for thrombosis in children with renal insufficiency are unique. In addition to the severity of renal insufficiency, individual characteristics of the children and disease-related factors may also affect the pharmacokinetics and pharmacodynamics of anticoagulant drugs. Among the anticoagulants available for pediatric use, unfractionated heparin and argatroban do not require dosage adjustment in patients with renal insufficiency, but they have to be administered intravenously, which limits their convenience. For subcutaneous low-molecular-weight heparins, enoxaparin has the most abundant clinical data in children, yet its dosage should be determined based on the patients’ renal function status. Warfarin, an oral anticoagulant, does not need dosage adjustment in the setting of renal insufficiency, but it requires frequent laboratory monitoring and is associated with numerous drug interactions. The oral direct oral anticoagulants rivaroxaban and dabigatran have sufficient pediatric data and necessitate dosage adjustment according to renal function; notably, both are available as oral suspensions, which confers a relative advantage in improving medication adherence in children.Conclusion: Each anticoagulant has unique characteristics and precautions for use in children with renal insufficiency. When selecting and adjusting the dosage of anticoagulants, it is essential to fully consider the children’s renal function status, the pharmacological properties of the drugs, and disease-related factors, so as to formulate the optimal anticoagulant regimen.