The practice of evidence-based medicine is based on the results of property designed, conducted and analyzed studies. Evidence for the safety and efficacy of therapies is established through clinical trials. However, there are a number of difficulties in the design and management of clinical trials in children. We explore the theoretical and ethical issues and difficulties of designing and conducting clinical trials in children, and illustrate the ways in which these challenges were encountered in two clinical trials assessing anticoagulant therapy in children with thrombophilia (PROTEKT (PROphylaxis of ThromboEmbolism in Kids Trial) and REVIVE (REVIparin in Venous ThromboEmbolism)). Means for overcoming these challenges are also addressed. (c) 2005 Elsevier Ltd. All rights reserved.
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McMaster Univ, Dept Pediat, Hamilton, ON, CanadaUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
Chan, Anthony K. C.
Goldenberg, Neil A.
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Univ Colorado, Dept Pediat, Sect Hematol Oncol Bone Marrow Transplantat, Aurora, CO USA
Univ Colorado, Mt States Reg Hemophilia & Thrombosis Ctr, Aurora, CO USAUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
Goldenberg, Neil A.
Ichord, Rebecca N.
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Childrens Hosp Philadelphia, Dept Neurol, Philadelphia, PA 19104 USAUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
Ichord, Rebecca N.
Journeycake, Janna M.
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Univ Texas SW Med Ctr Dallas, Dept Pediat, Dallas, TX 75390 USAUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
Journeycake, Janna M.
Nowak-Goettl, Ulrike
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Univ Hosp Kiel, Inst Clin Chem, Thrombosis & Hemostasis Unit, Kiel, GermanyUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
Nowak-Goettl, Ulrike
Vesely, Sara K.
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Univ Oklahoma, Hlth Sci Ctr, Dept Biostat & Epidemiol, Oklahoma City, OK 73104 USAUniv Melbourne, Royal Childrens Hosp, Dept Haematol, Dept Paediat,Murdoch Childrens Res Inst, Melbourne, Vic, Australia
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Hamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, CanadaHamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, Canada
Michelson, AD
Bovill, E
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Hamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, CanadaHamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, Canada
Bovill, E
Monagle, P
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Hamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, CanadaHamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, Canada
Monagle, P
Andrew, M
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Hamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, CanadaHamilton Civ Hosp, Res Ctr, Henderson Gen Div, Hamilton, ON L8V 1C3, Canada