Arterial thromboembolic disease: A single‐centre case series study

Monagle, Paul; Newall, Fiona; Barnes, Chris; Savoia, Helen; Campbell, Janine; Wallace, Timothy M.; Crock, Catherine

doi:10.1111/j.1440-1754.2007.01149.x

Cited by 46 publications

(30 citation statements)

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“…7,27 Mortality after pulmonary embolism is as high as 20%. 28 In a study of 98 pediatric patients, Monagle et al 29 demonstrated that direct arterial thrombosis-related mortality was 4% in infants and 9% in children in a study of 98 pediatric patients. Outcomes of arterial strokes and cerebral sinovenous thrombosis are poor, with high mortality, and up to two thirds of patients have resulting permanent neurological damage.…”

Section: Serious Complications Of Thrombosis and Surgical Outcomesmentioning

confidence: 99%

“…Cerebral arterial thrombosis carries a high risk of cardioembolic stroke, but noncerebral arterial thrombosis also carries substantial risk of ischemic injury. 29 Occlusive and symptomatic thrombi were at higher risk of complications. Finally, thromboses found in vessels where there had been indwelling access lines were at lower risk of complications, which might reflect their localization in peripheral vessels farther from central blood circulation.…”

Section: Serious Complications Of Thrombosis and Surgical Outcomesmentioning

confidence: 99%

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Risk, Clinical Features, and Outcomes of Thrombosis Associated With Pediatric Cardiac Surgery

et al. 2011

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Background— Thrombosis, usually considered a serious but rare complication of pediatric cardiac surgery, has not been a major clinical and/or research focus in the past. Methods and Results— We noted 444 thrombi (66% occlusive, 60% symptomatic) in 171 of 1542 surgeries (11%). Factors associated with increased odds of thrombosis were age <31 days (odds ratio [OR], 2.0; P =0.002), baseline oxygen saturation <85% (OR, 2.0; P =0.001), previous thrombosis (OR, 2.6; P =0.001), heart transplantation (OR, 4.1; P <0.001), use of deep hypothermic circulatory arrest (OR, 1.9 P =0.01), longer cumulative time with central lines (OR, 1.2 per 5-day equivalent; P <0.001), and postoperative use of extracorporeal support (OR, 5.2; P <0.001). Serious complications of thrombosis occurred with 64 of 444 thrombi (14%) in 47 of 171 patients (28%), and were associated with thrombus location (intrathoracic, 45%; extrathoracic arterial, 19%; extrathoracic venous, 8%; P <0.001), symptomatic thrombi (OR, 8.0; P =0.02), and partially/fully occluding thrombi (OR, 14.3; P =0.001); indwelling access line in vessel (versus no access line) was associated with lower risk of serious complications (OR, 0.4; P =0.05). Thrombosis was associated with longer intensive care unit (+10.0 days; P <0.001) and hospital stay (+15.2 days; P <0.001); higher odds of cardiac arrest (OR, 4.9; P <0.001), catheter reintervention (OR, 3.3; P =0.002), and reoperation (OR, 2.5; P =0.003); and increased mortality (OR, 5.1; P <0.001). Long-term outcome assessment was possible for 316 thrombi in 129 patients. Of those, 197 (62%) had resolved at the last follow-up. Factors associated with increased odds of thrombus resolution were location (intrathoracic, 75%; extrathoracic arterial, 89%; extrathoracic venous, 60%; P <0.001), nonocclusive thrombi (OR, 2.2; P =0.01), older age at surgery (OR, 1.2 per year; P =0.04), higher white blood cell count (OR, 1.1/10 9 cells per 1 mL; P =0.002), and lower fibrinogen (OR, 1.4/g/L; P =0.02) after surgery. Conclusions— Thrombosis affects a high proportion of children undergoing cardiac surgery and is associated with suboptimal outcomes. Increased awareness and effective prevention and detection strategies are needed.

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Section: Serious Complications Of Thrombosis and Surgical Outcomesmentioning

confidence: 99%

Section: Serious Complications Of Thrombosis and Surgical Outcomesmentioning

confidence: 99%

Risk, Clinical Features, and Outcomes of Thrombosis Associated With Pediatric Cardiac Surgery

et al. 2011

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“…The few researches on the argument would seem to orient towards the surgical treatment as a first-line intervention, life-saving, even in case of infection of the atrial catheter. In fact only in one study it was reported a positive outcome in two patients treated with anticoagulant medical therapy [10]. Recent researches have also linked the increased incidence of thrombotic events with genetic disorders of coagulation [11], and therefore suggest to comprehensively study the coagulation factors of the patients to reduce the recurrency of those events [12].…”

Section: Discussionmentioning

confidence: 99%

Ventricular-Atrial Junction in Post Hemorrhagic Hydrocephalus: A Rare Case of Massive Catheter Atrial Thrombosis

2017

JCCR

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Although the infant age is notoriously the hardest period of life to be affected by thromboembolic accidents in the medical literature there are still very few studies on this issue, and therefore the treatment of these pathological processes is, on this stage of life, even today, a real challenge. In fact the role of medical therapy is still debated, either as regards the most appropriate medical procedure to use, or the effectiveness, and because of its limits which were often described and because of there are no protocols which could be really sure or recommended . We describe the case of a patient who came to our observation at the age of 11 months for a severe thrombosis of the ventricle-atrial shunt catheter placed after a post-hemorrhagic hydrocephalus. In our division, the patient was subjected to medical therapy, first with only heparin, then associated with thrombolytics. This case emphasizes the difficulties in the therapeutic management of pediatric patients with thrombosis, it emphasizes the limits of any medical treatment and reiterates the need to guide patients with these phenomena promptly to surgery, which is the only effective and decisive therapy.

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“…Los niños mayores tienen más probabilidades de desarrollar tromboembolia en el sistema nervioso central. 10 Según el Registro Internacional Canadiense, el 89% de los casos de trombosis estuvieron asociados con la colocación de catéteres intravasculares. 11 Brus, et al 12 informaron que la formación de coágulos, la fibrinólisis y el sistema calicreína-cininas se activan simultáneamente en los recién nacidos prematuros con SDR grave, lo que resulta en alteraciones en la coagulación.…”

Section: Discussionunclassified

Tromboembolia arterial y amputación de una extremidad en un neonato posterior al síndrome de dificultad respiratoria. Caso clínico

2015

arch Argent Pediat

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Presentación de casos clínicos RESUMENLa tromboembolia en los recién nacidos es un problema grave. Los factores de riesgo más importantes son iatrogénicos, entre ellos, el uso de sondas umbilicales o vías centrales permanentes. Entre otros factores de riesgo, se incluyen la asfixia, la deshidratación, la septicemia, la cardiopatía, el síndrome de dificultad respiratoria, la coagulación intravascular diseminada, la trombofilia congénita (deficiencia de proteína C o proteína S), la diabetes mellitus materna y la transferencia pasiva de anticuerpos antifosfolípidos maternos. Los recién nacidos son más vulnerables que los adultos a presentar una trombosis debido a su menor capacidad fibrinolítica. Describimos el caso de una recién nacida de un día de vida con tromboembolia arterial en el miembro inferior, sin vía central. La tromboembolia en este caso estuvo asociada con un síndrome de dificultad respiratoria. Se realizó trombólisis, tratamiento anticoagulante y trombectomía quirúrgica. Posteriormente, se amputó el miembro inferior por debajo de la rodilla. Palabras clave: amputación, arterias, síndrome de dificultad respiratoria del recién nacido, tromboembolia http://dx

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Arterial thromboembolic disease: A single‐centre case series study

Abstract: Arterial TE occurred as frequently as venous TE in our tertiary paediatric population. The clinical outcome and long term sequelae of such events are significant.

Cited by 46 publications

References 34 publications

Risk, Clinical Features, and Outcomes of Thrombosis Associated With Pediatric Cardiac Surgery

Risk, Clinical Features, and Outcomes of Thrombosis Associated With Pediatric Cardiac Surgery

Ventricular-Atrial Junction in Post Hemorrhagic Hydrocephalus: A Rare Case of Massive Catheter Atrial Thrombosis

Tromboembolia arterial y amputación de una extremidad en un neonato posterior al síndrome de dificultad respiratoria. Caso clínico

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