Antiplatelet Drugs in the Management of Thrombotic/Ischemic Events in Children

There is a paucity of data on antiplatelet therapy in the management of thrombotic/ischemic events in children, with very few randomized controlled trials. Because of this lack of rigorous evidence, no antiplatelet drug is approved for use in children by the U.S. Food and Drug Administration—although aspirin (a cyclooxygenase 1 inhibitor), clopidogrel (a P2Y12 antagonist) and dipyridamole (a phosphodiesterase inhibitor) are routinely used off-label in children. In addition, the P2Y12 antagonists ticagrelor and cangrelor are under active investigation as antiplatelet agents in children. Pediatric guidelines for antiplatelet therapy are mostly weak recommendations based on low quality of evidence.