Efficacy and safety of clopidogrel in children with diarrhea associated hemolytic uremic syndrome |
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Authors: | Seltz L Barry Bakel Leigh Anne Tiehen Jennifer Gao Dexiang Cadnapaphornchai Melissa A Lum Gary Ford Douglas |
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Affiliation: | a Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USAb Colorado School of Public Health, Biostatistics and Informatics. 13001 E 17th Place, Aurora, CO 80045, USAc Department of Pediatrics, Section of Nephrology, Children's Hospital Colorado and the University of Colorado School of Medicine. 13123 E 16th Ave, Aurora, CO 80045, USA |
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Abstract: | IntroductionHemolytic 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 MethodsWe 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.ResultsOf 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 10.1 g/dL, 53 × 103/μL, and 2.3 mg/dL respectively. Clopidogrel (median dose 1 mg/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).ConclusionsChildren with diarrhea associated hemolytic uremic syndrome treated with clopidogrel have outcomes comparable to untreated patients. Bleeding complications may occur. |
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Keywords: | HUS, hemolytic uremic syndrome D +, diarrhea associated TTP, thrombotic thrombocytopenic purpura CNS, central nervous system PAI, platelet aggregation inhibitors GFR, glomerular filtration rate |
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