Deep vein thrombosis in pediatric patients

Jaffray, Julie

doi:10.1002/pbc.26881

Cited by 57 publications

(31 citation statements)

References 82 publications

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“…However, the risk of thrombotic events cannot be completely excluded as thrombosis in children is extremely rare. 12 Younger age is associated with greater odds of difficult IV access. 13 The desire to avoid CVL insertion and its complications may play a crucial role in the pediatrician's decision to delay ITI or to prefer emicizumab prophylaxis over standard ITI.…”

Section: Discussionmentioning

confidence: 99%

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Barg

Avishai

Budnik

et al. 2019

Pediatric Blood & Cancer

127

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Background: Emicizumab is a bispecific antibody that bridges factor IXa and factor X to restore hemostasis in patients with hemophilia A (HA). Its efficacy and safety have been proven in multicenter trials. However, real world data regarding its use in very young children are currently lacking. Ancillary test results for monitoring emicizumab's hemostatic effect and their clinical correlations are scarce. Methods:Children with HA and inhibitors treated by emicizumab were prospectively followed at our center. Laboratory follow-up included rotational thromboelastometry (ROTEM) and thrombin generation (TG), prior to and during treatment.Results: Eleven children whose median age was 26 months were treated by emicizumab and followed for a median of 36 weeks. During follow-up, none experienced hemarthrosis or any other spontaneous bleeds. For 7/11 patients, emicizumab prophylaxis was sufficient to maintain hemostasis without additional supplemental therapy. Only 4/11 patients were occasionally treated with recombinant activated FVII for trauma. Two minor surgeries were safely performed without supplemental therapy while another procedure was complicated by major bleeding. TG parameters improved for all patients, correlating with their clinical status. Interestingly, the lowest TG values were obtained for patients experiencing bleeding episodes, while ROTEM parameters in all patients were close to the normal range. Conclusions:This study confirms the safety and efficacy of emicizumab in reducing bleeds in young children with HA with inhibitors, including infants. However, surgeries warrant caution as emicizumab prophylaxis may not be sufficient for some procedures. TG may more accurately reflect the hemostasis state than ROTEM in pediatric patients treated with emicizumab. K E Y W O R D Semicizumab, hemophilia A, inhibitors, ROTEM, thrombin generation

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Section: Discussionmentioning

confidence: 99%

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Barg

Avishai

Budnik

et al. 2019

Pediatric Blood & Cancer

127

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“…Flow stagnation can result from sessile position of an individual, such as observed after surgery (especially an orthopedic one), in a bed-ridden position or even during long-haul flights. In pediatric patients, immobility for more than 72 h is also considered one of the main factors triggering DVT with each additional day of hospitalization increasing the risk by 3% [17] . Venous stasis increases also with age and it was observed that contrast material stays in the veins of elderly patients for up to 1 h after venography [18] .…”

Section: Stage 1: Blood Flow Stagnancy and Hypoxia Trigger Dvtmentioning

confidence: 99%

Immune Factors in Deep Vein Thrombosis Initiation

Budnik

Brill

2018

Trends in Immunology

139

105

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Deep vein thrombosis (DVT) is a major origin of morbidity and mortality. While DVT has long been considered as blood coagulation disorder, several recent lines of evidence demonstrate that immune cells and inflammatory processes are involved in DVT initiation. Here, we discuss these mechanisms, in particular, the role of immune cells in endothelial activation, and the immune cascades leading to expression of adhesion receptors on endothelial cells. We analyze the specific recruitment and functional roles of different immune cells, such as mast cells and leukocytes, in DVT. Importantly, we also speculate how immune modulation could be used for DVT prevention with a lower risk of bleeding complications than conventional therapeutic approaches.

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“…Interrupted flow usually results from immobilisation of the person for reasons such as bed-ridden position after surgery, paralysis or long-haul flights. For example, in paediatric patients, lack of movement exceeding 3 days is a recognised risk factor for venous thrombosis with each additional day of stay at hospital increasing the probability for DVT by 3% 7 . Blood flow in veins becomes slower 8 and valves stiffer with age which correlates with greatly increased prevalence of DVT in elderly people 9 .…”

mentioning

confidence: 99%

The role of valve stiffness in the insurgence of deep vein thrombosis

et al. 2020

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Deep vein thrombosis is a life-threatening development of blood clots in deep veins. Immobility and blood flow stagnancy are typical risk factors indicating that fluid dynamics play an important role in the initiation of venous clots. However, the roles of physical parameters of the valves and flow conditions in deep vein thrombosis initiation have not been fully understood. Here, we describe a microfluidics in vitro method that enabled us to explore the role of valve elasticity using in situ fabrication and characterisation. In our experimental model the stiffness of each valve leaflet can be controlled independently, and various flow conditions were tested. The resulting complex flow patterns were detected using ghost particle velocimetry and linked to localised thrombus formation using whole blood and an aqueous suspension of polystyrene particles. In particular, valves with leaflets of similar stiffness had clot formation on the valve tips whereas valves with leaflets of different stiffness had clot formation in the valve pocket.

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Deep vein thrombosis in pediatric patients

Cited by 57 publications

References 82 publications

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Emicizumab prophylaxis among infants and toddlers with severe hemophilia A and inhibitors—a single‐center cohort

Immune Factors in Deep Vein Thrombosis Initiation

The role of valve stiffness in the insurgence of deep vein thrombosis

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