The incidence of venous thromboembolism (VTE) in children is steadily rising [1,2]. While some of this increase may be due to increased recognition, it is likely that this represents a true increase in incidence. Much of the increase is due to the advancements in the management of critically ill children and particularly the widespread use of central venous catheters, which are the leading cause for the development of VTE. Treatment of VTE in children involves the use of anticoagulation and occasionally, thrombolytic agents. Treatment guidelines for the management of VTE in children have been published; however, these are largely based on low levels of evidence in the published literature, and relevant to this chapter, do not discuss the use of newer anticoagulants . This chapter will provide a brief overview of the current (standard) anticoagulants in use in children (details can be found in other chapters), in particular discussing their limitations as they relate to the properties of the newer agents. This will be followed by a discussion of the data available regarding the use of new anticoagulants. Table 15.1 provides a historical context of anticoagulant clinical use and studies in children.
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