Central Venous Line Thrombosis in Children and Young Adults With Thalassemia Major

Finkelstein, Yaron; Yaniv, Isaac; Berant, Michael; Zilber, Rama; Garty, Ben‐Zion; Epstein, O; Lahav, Judith; Tamary, Hannah

doi:10.1080/08880010490457042

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…Surveillance studies in long‐term CVLs showed that aVTE continued to occur as long as CVL was in place . Chronic vascular changes like stenosis or collateral vessel formation were shown in 30% to 50% of the vessels with long‐term CVL …”

Section: Resultsmentioning

confidence: 99%

“…Thrombophilia testing was reported in 13 studies with limited information on the timing of the testing and the assays performed. No association was found between inherited or acquired thrombophilia and the risk of CVL‐related aVTE . One study noted that transient acquired thrombophilia occurred in all children with acute lymphoblastic leukemia (ALL) during asparaginase therapy, yet no association was observed with frequency of aVTE .…”

Section: Resultsmentioning

confidence: 99%

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Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

Sharathkumar¹,

Biss²,

Kulkarni³

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic," "incidental," or "clinically silent/occult" VTE. Objective: To understand the epidemiology, management, and outcomes of uVTE in children. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). Results: Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I 2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%-24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non-CVL settings included post-spinal surgery, post-splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long-term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor-associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. Conclusion: Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and | 1101 SHARATHKUMAR eT Al.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

Sharathkumar¹,

Biss²,

Kulkarni³

et al. 2020

Journal of Thrombosis and Haemostasis

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“…While these associations are established for spontaneous DVT, their significance for secondary DVT is less clear. Studies in patients with CVL have reported conflicting results on the association of prothrombotic conditions with DVT . Based on positive associations in some studies, some authors have suggested screening for prothrombotic conditions in patients with CVL .…”

Section: Introductionmentioning

confidence: 99%

No impact of endogenous prothrombotic conditions on the risk of central venous line‐related thrombotic events in children: results of the KIDCAT study (KIDs with Catheter Associated Thrombosis)

Thom

Male

Mannhalter

et al. 2014

Journal of Thrombosis and Haemostasis

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Summary Background and objective Central venous lines (CVLs) are the major exogenous risk factor for deep venous thrombosis (DVT) in children. The study objective was to assess whether endogenous prothrombotic conditions contribute to the risk of CVL‐related DVT in children. Methods This was a cohort study of consecutive children with heart disease requiring CVLs for perioperative care. CVLs were inserted percutaneously in the upper venous system and patients received prophylaxis with continuous unfractionated heparin (50 u kg−1 d−1). Blood samples to test for prothrombotic conditions were collected prospectively and assayed in a blinded fashion. Outcome assessment was by screening for DVT by venography, venous ultrasound and echocardiography. Results The study population consisted of 90 children, median age 2.7 years (0 months–18 years). Prevalence rates of antithrombin deficiency, protein C deficiency, protein S deficiency, heterozygous factor V Leiden, prothrombin G20210A mutation, methylentetrahydrofolate C677TT genotype, hyperhomocysteinemia, lupus anticoagulant, anticardiolipin antibodies and increased levels of lipoprotein (a) were within the range reported for the general population. At least one prothrombotic condition was present in 38% of children and combined abnormalities in 8%. The incidence of DVT was 28% (25/90), and most DVTs were asymptomatic. None of the prothrombotic conditions showed a significant association with DVT. The population attributable risk (i.e. the risk of DVT in the overall population attributable to a specific condition) did not exceed 2.2%. Conclusion Prothrombotic conditions did not have an important impact on the risk of DVT in children with short‐term CVLs. The results of the study suggest that screening for prothrombotic conditions is not justified in this setting.

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“…We considered articles on grounds of ischemic cerebral thrombosis in patients with b-thalassemia major, and b-thalassemia intermedia. The articles reporting hemorrhagic type of stroke or stroke with specific underlying disease or clinical situations such as stroke in a b-thalassemia intermedia patient with moyamoya syndrome [36], and cerebral thrombosis related to central venous line [37] were excluded from the study. Finally, 24 relevant articles were included in this systematic review.…”

Section: Study Selectionmentioning

confidence: 99%

Cerebral thrombosis in patients with β-thalassemia

Haghpanah

Karimi

2012

Blood Coagulation &Amp; Fibrinolysis

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A hypercoagulable state has been documented in patients with β-thalassemia. It could result in thromboembolic events in several organs including brain involvement, which deserves particular attention. We summarized the prevalence of cerebral involvement in patients with β-thalassemia worldwide. We conducted an electronic search on PUBMED (MEDLINE), SCOPUS, and Google Scholar databases up to January 2011. Overall 152 thalassemic patients with cerebral thromboembolic events and a proportion of 1.13% (134 of 11770) were recorded. From all patients with cerebral thromboembolic events, 74 (48%) were splenectomized. Cerebral thromboembolic events were reported after transfusion in six β-thalassemia major, and two β-thalassemia intermedia patients. Three β-thalassemia major patients had irregular transfusion and 22 β-thalassemia intermedia patients were not transfused. Thrombocytosis were determined in 11 β-thalassemia major, and 15 β-thalassemia intermedia patients. Cardiomyopathy was present in 13 β-thalassemia major and four β-thalassemia intermedia patients. Also, nine β-thalassemia major patients had diabetes. Activated protein C resistant, decreased protein C or protein S or plasminogen level was detected in eight β-thalassemia major patients. Cerebral involvement appears to be associated with increasing age, transfusion naivety, splenectomy, thrombocytosis, intensive transfusion, decreased protein C level, and having risk factors for cerebrovascular accident such as cardiomyopathy, and diabetes. In light of these findings, diagnostic MRI is recommended in high-risk groups to screen for early asymptomatic brain damage. If brain ischemia is found, the administration of antiplatelet aggregants or blood transfusion is likely to be beneficial. In addition, in thalassemic patients who complicated with a thromboembolic event, secondary prophylaxis could be helpful to prevent cerebral thromboembolic events.

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Central Venous Line Thrombosis in Children and Young Adults With Thalassemia Major

Cited by 12 publications

References 29 publications

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

No impact of endogenous prothrombotic conditions on the risk of central venous line‐related thrombotic events in children: results of the KIDCAT study (KIDs with Catheter Associated Thrombosis)

Cerebral thrombosis in patients with β-thalassemia

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