How We Manage Pediatric Deep Venous Thrombosis

Betensky, Marisol; Bittles, Mark A.; Colombani, Paul M.; Goldenberg, Neil A.

doi:10.1055/s-0036-1597762

Cited by 13 publications

(1 citation statement)

References 119 publications

(171 reference statements)

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“…VTE complications range from bleeding with anticoagulation therapy, recurrent VTE (reported to be between 2% and 21%), development of PE, limb ischemia, a 1% to 4% mortality rate secondary to large vein thrombosis, and a 2 to 6-fold increased risk of in-hospital mortality. [23][24][25][26][27] Postthrombotic syndrome, characterized by chronic limb pain, edema, ulceration, and limitation of activity, significantly impacts the quality of life of affected patients 28,29 and has been reported with a frequency of 9.5% to 70%. 2 In addition, hospital-acquired VTE in children is associated with an increased length of stay and costs.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database

Wright

Qamar

McLaughlin

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Venous thromboembolism (VTE) is a frequent occurrence during treatment for adults with sarcoma. The incidence and underlying risk factors of postsurgical VTE in children and adolescents undergoing resection of sarcoma are unknown. Methods: Using International Classification of Disease revision-9 diagnostic and procedure codes, the Pediatric Health Information System database was queried for patients aged 18 years and younger, discharged from 2004 to 2015 with a diagnosis of lower extremity malignant neoplasm who had a tumor resection or amputation performed during the encounter. Malignant neoplasms of the pelvic bones and soft tissues were categorized as “pelvis tumors”, whereas malignant neoplasms of bone and soft tissues of the lower limbs were categorized as “lower limb tumors”. Hospitalizations were evaluated for the occurrence of VTE. Demographic characteristics (age at admission, sex, race, and race/ethnicity) and incidence of VTE were reported. Results: There were 2400 patients identified. Of these, 19 experienced VTE (0.79%) during their surgical hospitalization encounter. By anatomic group, the rate of VTE was 1.4% (CI: 0.5%-3.2%) for tumors in the pelvis and 0.6% (CI: 0.3%-1.0%) in lower limb tumors. Categorizing by age, the incidence of VTE was 1.2% in patients aged zero to 5, 0.3% in patients 6 to 13, and 1.2% in patients 14 to 18 years old. (Table 1). The extremely low rate of VTE occurrence precluded further analysis of risk factors. Conclusions: In this analysis, postsurgical VTE during hospitalization after pelvic and lower extremity sarcoma resection was an uncommon event in children and adolescents. There seemed to be an increased incidence of postsurgical VTE in pelvic tumors when compared with lower limb tumors, however, the rarity of all events precluded formal statistical analysis. A more robust data set would be required to determine if there are subsets of children and adolescents with sarcoma at higher risk of VTE that could benefit from thromboprophylaxis in the postoperative setting. Level of Evidence: Level II.

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Section: Discussionmentioning

confidence: 99%

The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database

Wright

Qamar

McLaughlin

et al. 2023

Journal of Pediatric Orthopaedics

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Thrombolytic therapy in preterm infants: Fifteen‐year experience

Grizante-Lopes

Garanito

Celeste

et al. 2020

Pediatric Blood & Cancer

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Objective To report a single‐center experience with thrombolytic therapy using recombinant tissue plasminogen activator (rt‐PA) in preterm neonates with severe thrombotic events, in terms of thrombus resolution and bleeding complications. Study design This retrospective study included 21 preterm neonates with severe venous thrombotic events admitted to the neonatal intensive care unit, identified in our pharmacy database from January 2001 to December 2016, and treated with rt‐PA until complete or partial clot lysis, no‐response or bleeding complications. Our primary outcome was thrombus resolution. Results Twenty‐one preterm neonates were treated with rt‐PA for an average of 2.9 cycles. Seventeen patients (80.9%) had superior vena cava thrombosis and superior vena cava syndrome. All patients had a central venous catheter, parenteral nutrition, mechanical ventilation, and sepsis. Fifteen patients (71.4%) were extremely preterm, 11 (52.4%) were extremely low birth weight, and seven (33.3%) were very low birth weight. The patency rate was 85.7%, complete lysis occurred in 11 (52.4%) patients, and partial lysis in seven (33.3%). Minor bleeding occurred in five (23.8%) patients, three patients (14.2%) had clinically relevant nonmajor bleeding events, and major bleeding occurred in six (28%) patients. Conclusion In this study, the rate of thrombus resolution in preterm neonates treated with rt‐PA were similar to the percentages reported in children and adolescents, with a high rate of bleeding. Therefore, rt‐PA thrombolytic therapy should only be considered as a treatment option for severe life‐threatening thrombosis in premature neonates for whom the benefits of the thrombolytic treatment outweigh the risks of bleeding.

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IVC Filter Placement: Accepted and Relative Indications

Paratore

Montgomery

2020

Placement and Retrieval of Inferior Vena Cava Filters

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How We Manage Pediatric Deep Venous Thrombosis

Cited by 13 publications

References 119 publications

The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database

The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database

Thrombolytic therapy in preterm infants: Fifteen‐year experience

IVC Filter Placement: Accepted and Relative Indications

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