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

Abstract：

INTRODUCTION:Hemolytic uremic syndrome is a thrombotic microangiopathy. Clopidogrel, a recently developed platelet aggregation inhibitor, has not been previously reported as a treatment for this illness. Our study's objective was to explore the efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome. MATERIALS AND METHODS:We performed a retrospective chart review of all children (≤ 18 years) 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 5 years; 40% were male. Initial median hemoglobin, platelet count, and serum creatinine were 10.1g/dL, 53 × 10(3)/μL, and 2.3mg/dL respectively. Clopidogrel (median dose 1mg/kg/d) was given for a median of 4 days (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 9 days (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 11 days in thirteen clopidogrel treated children compared to 21 days in five untreated patients (P=0.04). CONCLUSIONS:Children with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur.

journal_name

Thromb Res

journal_title

Thrombosis research

authors

Seltz LB,Bakel LA,Tiehen J,Gao D,Cadnapaphornchai MA,Lum G,Ford D

doi

10.1016/j.thromres.2012.05.017

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

e26-30

issue

eissn

0049-3848

issn

1879-2472

pii

S0049-3848(12)00239-3

journal_volume

130

pub_type

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