Pediatric Cardiology and Cardiac Surgery
Vol.26 No.5 2010 (400-406)

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Kiyoshi Ogawa, Masatoshi Iijima, Reiji Ito, Sadataka Kawachi, Kenji Sugamoto, Takashi Hishitani, and Kenji Hoshino

Division of Pediatric Cardiology, Saitama Children’s Medical Center, Saitama, Japan


Background: Although prolonged antiplatelet therapy with aspirin is widely recommended for children with heart disease, aspirin alone may not be sufficient to prevent thrombotic events. The safety and efficacy of thienopyridine derivatives such as ticlopidine and clopidogrel have been established in adult patients with coronary artery disease. However, very limited information has been published on the use of ticlopidine in a pediatric population.
Methods: A retrospective study of all children treated with ticlopidine was performed. 87 patients with congenital or acquired heart disease were identified. Those patients were divided into three different groups by age and procedures at ticlopidine use.
Results: The total daily dose of ticlopidine ranged from 1.0 to 7.4 mg/kg/day. The relationship between the degree of ADP-induced platelet aggregation inhibition and the dose of ticlopidine was not linear in any of the three groups. Two patients developed thrombotic events after systemic to pulmonary artery shunting. There were no serious bleeding events or adverse gastrointestinal effects attributed to the ticlopidine. Hematological abnormalities were documented in 7 patients. Isolated thrombocytopenia was identified in 6 patients 2 to 13 years after the initiation of ticlopidine. Platelet counts gradually decreased in all patients.
Conclusions: Ticlopidine was well tolerated in our pediatric patients with heart disease, and adverse events were minimal. The doses of ticlopidine were considerably lower than those for adult use. Patients should be monitored for thrombocytopenia during ticlopidine administration.