Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Feb;31(1):30-36.
doi: 10.5683/JPPT-25-00024. Epub 2026 Feb 9.

Clopidogrel Dosing Scheme in Pediatric Cardiac Patients 0-24 Months Old Using P2Y12 Reaction Unit Monitoring

Pilar Anton-Martin  1 , Carli Coalter  2 , Kathryn DeAvilla  3 , Meredith Ray  2 , Benjamin W Kozyak  1 , Mario Briceno-Medina  4 , Mark Rayburn  5
Affiliations

Clopidogrel Dosing Scheme in Pediatric Cardiac Patients 0-24 Months Old Using P2Y12 Reaction Unit Monitoring

Pilar Anton-Martin et al. J Pediatr Pharmacol Ther. 2026 Feb.

Abstract

Objective: The use of clopidogrel for postprocedural primary thromboprophylaxis in pediatric cardiac patients is becoming more common. This study aimed to explore, using P2Y12 reaction unit (PRU) values, whether the currently recommended static low clopidogrel dose of 0.2 mg/kg/day for patients under 24 months is optimal, or if a gradual dosage escalation would be more appropriate; and to propose a hypothetical dosing scheme for clopidogrel thromboprophylaxis in these patients.

Methods: Exploratory, retrospective cohort study in cardiac patients 0-24 months old receiving clopidogrel for thromboprophylaxis between 2018 and 2021. Data collected from medical records included patient demographics and diagnoses, clopidogrel dosing and duration, PRU values, concomitant anticoagulant and antiplatelet therapies, adverse events, and outcomes. Exponential and linear regression analyses were employed to model dosage as a function of time using therapeutic PRU values and to identify the best-fit dosing scheme for clopidogrel.

Results: Forty-four cardiac patients on clopidogrel for thromboprophylaxis were included. No statistically significant difference was observed between the predicted dosing from the fitted and the referent regressions, indicating that the observed clopidogrel doses that achieved a therapeutic PRU followed a dosing gradient inconsistent with the static low dose (0.2 mg/kg/day) recommended by the Platelet Inhibition in Children On cLOpidogrel (PICOLO) trial during the first 24 months of age.

Conclusions: Pediatric cardiac patients may require a gradual escalation of clopidogrel dosing with age, in contrast to the static low dose recommended by the PICOLO trial during the first 24 months of life. An age-based dosing scheme may prove beneficial for this age group. Prospective studies evaluating age-based clopidogrel dosing in this patient population could offer further insight into this relationship.

Keywords: P2Y12 reaction units.; PRU; cardiac; clopidogrel; dosing scheme; pediatrics.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Exponential and linear trend of clopidogrel doses with therapeutic P2Y12 reaction unit (PRU) values for patients 0–24 months.
Figure 2.
Figure 2.
Exponential and linear trend of clopidogrel doses with therapeutic P2Y12 reaction unit (PRU) values for patients 0–12 months
See this image and copyright information in PMC

References

    1. Prodhan P, Steiner M, Greiten L. Systemic-to-pulmonary artery shunt thromboprophylaxis: searching for the Holy Grail. Pediatr Crit Care Med. 2022;23(9):757–759. - PubMed
    1. Piekarski BL, Rogers J, Zurakowski D et al. Exploratory use of glycoprotein IIb/IIIa Inhibition in prevention of Blalock-Taussig shunt thrombosis. Pediatr Crit Care Med. 2022;23(9):727–735. - PubMed
    1. Monagle P, Chan AKC, Goldenberg NA et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S–e801S. - PMC - PubMed
    1. Sangkuhl K, Klein TE, Altman RB. Clopidogrel pathway. Pharmacogenet Genomics. 2010;20(7):463–465. - PMC - PubMed
    1. Savi P, Pereillo JM, Uzabiaga MF et al. Identification and biological activity of the active metabolite of clopidogrel. Thromb Haemost. 2000;84(5):891–896. - PubMed

LinkOut - more resources