HEEADSSS assessment for adolescents requiring anticoagulation therapy: Table 1

Abstract

The care of adolescents with complex chronic illness needs to be developmentally appropriate to encourage adherence, knowledge retention and self-management. There has been an increase in the number of adolescents requiring long-term or lifelong anticoagulation therapy, related to either an underlying illness or idiopathic deep vein thrombosis. The burden of anticoagulant therapy, the associated risks and the required lifestyle changes can significantly impact on psychosocial well-being in the adolescent patient. This review identifies issues pertinent to adolescent anticoagulation management and discusses strategies to support optimal management. The HEEADSSS (Home, Education and employment, Eating, Activities with peers, Drugs, Sexual activity, Suicide and depression, and Safety) framework was used to provide guidance in undertaking a psychosocial assessment of adolescents requiring anticoagulant therapy in conjunction with a structured education strategy. Adolescent anticoagulant management strategies employing developmentally appropriate assessment and education will likely result in improved therapeutic outcomes for the patient and potentially facilitate transition to adult-based care.

Recommendations for the development of a dedicated pediatric anticoagulation service: communication from the SSC of the ISTH

“…The provision of a scheduled anticoagulant outpatient clinic supports optimal management, by facilitating anticoagulation education for patients and families , assessing the suitability of monitoring plans, and developing an effective relationship between patients and the managing team . No robust evidence supports specific recommendations regarding the optimal frequency of outpatient review, the duration of clinic appointments, or the contribution of face‐to‐face vs. information technology‐supported (SMS, email, and telephone) engagement.…”

Venous Thromboembolism in Children: Is It Preventable?

“…Post-thrombotic syndrome Occurs in 10 to 25% of children with extremity DVT. 15 Occurs in 6% of those with CVC for treatment of malignancy but no symptomatic DVT 16 Loss of venous access Psychological and lifestyle implications Restriction of physical activities, needle phobia, burden of anticoagulant monitoring, fear of recurrent thrombosis or bleeding, dietary and alcohol restrictions, changes in physical appearance 19,20 Health-related cost Extended hospital stay, outpatient monitoring of anticoagulant therapy, loss of productivity of parent/caregiver Abbreviations: CVST, cerebral venous sinus thrombosis; CVC, central venous catheter; DVT, deep vein thrombosis; PE, pulmonary embolism.…”

Recommendations for future research in relation to pediatric pulmonary embolism: communication from the SSC of the ISTH

“…It is therefore important to assess long‐term outcomes (as shown in Table ) in prospective cooperative studies. Although the psychosocial impact of PE occurring in childhood has been little studied, previous evaluation of QoL tools for children and adolescents receiving anticoagulant therapy suggest that there may be psychological, behavioral and social problems associated with this potentially life‐threatening diagnosis, the burden of anticoagulant monitoring, the need for lifestyle modification, and the physical symptoms of PE .…”