Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia, Therese M.; Massicotte, M. Patricia; Tweddell, James S.; Barst, Robyn J.; Bauman, Mary E.; Erickson, Christopher C.; Feltes, Timothy F.; Foster, Elyse; Hinoki, Kathleen; Ichord, Rebecca; Kreutzer, Jacqueline; McCrindle, Brian W.; Newburger, Jane W.; Tabbutt, Sarah; Todd, Jane L.; Webb, Catherine L.

doi:10.1161/01.cir.0000436140.77832.7a

Cited by 298 publications

(261 citation statements)

References 732 publications

(703 reference statements)

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“…Modified from Giglia et al 246 Copyright © 2013, American Heart Association, Inc. ) with careful monitoring of coagulation parameters to prevent bleeding, maintaining the fibrinogen level >100 mg/dL and platelet count >50 000/mm 3 . 251 After completion of tPA, heparin dosage is increased as appropriate for age.…”

Section: Treatment Of Coronary Artery Thrombosismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Treatment Of Coronary Artery Thrombosismentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

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2,863

4,124

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“…Information on the potential benefits and risks of preventive anticoagulation in children is scarce in medical literature. Recommendations regarding thromboprophylaxis in children have been given in some countries (England [2], United States [27,28]) but in France, no consensus exists, hence thromboprophylaxis in children is extrapolated from recommendations for adults [16] and currently mostly administered on an individual basis weighting between thrombotic risks and benefits of anticoagulation for each situation [3]. Eustratiades et al [29] studied thromboprophylaxis for spinal surgery in children.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism due to Heparin-Induced Thrombocytopenia (HIT): A Case Report of an 11-year-old Child Undergoing Scoliosis Surgery and Literature Review

Journeau¹,

Muller²,

Boudard³

2017

J Hematol Thrombo Dis

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“…Moreover, many CHD patients are at higher risk for morbidity or mortality due to thrombosis, for example, due to paradoxical embolization of thrombus (in right-to-left shunts), occlusion of collaterals, or hemodynamic disturbance (e.g., Fontan-palliated patients and those with PH). Detailed CHD-specific recommendations regarding prevention and management of thrombosis have been published, but the majority of existing data relates to pediatric populations [64].…”

Section: Thrombosis In Chdmentioning

confidence: 99%

“…Indeed, hemostatic improvement was seen with phlebotomy and more impaired coagulation with iron supplementation [14]. Counterintuitively, this suggests a role for phlebotomy in polycythemic CCHD patients preoperatively or during active bleeding [7,14,64].…”

Section: Hematologic Consequences Of Cchdmentioning

confidence: 99%

“…Chronic prevention or treatment of hyperviscosity by phlebotomy must be balanced against the risk of provoking iron deficiency, and current ACHD guidelines do not support routine phlebotomy to prevent hyperviscosity. Rather, therapeutic phlebotomy is reserved only for symptomatic hyperviscosity with hemoglobin 420 mg/dL and hematocrit 465% [7,64]. There are case reports of hydroxyurea treatment, but further study is needed [77].…”

Section: Hyperviscosity In Cchdmentioning

confidence: 99%

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Extra-cardiac manifestations of adult congenital heart disease

Gaeta

Ward

Krasuski

2016

Trends in Cardiovascular Medicine

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a b s t r a c tAdvancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations.Key words: Cardiovascular disease, Adult congenital heart disease, Pulmonary hypertension. Advances in the diagnosis and management of congenital heart disease (CHD) over the past several decades have greatly improved longevity and quality of life in the CHD population. Palliative or corrective interventions are now available for nearly every type of congenital cardiac lesion, and approximately 90% of affected children now survive to adulthood [1]. Adults with CHD (ACHD) already outnumber pediatric CHD patients, and this population is expected to grow by 5% per year [1,2]. Strikingly, the median age of severe CHD patients has increased from 11 years in 1985 to 25 years in 2010 [3]. Continued improvement in CHD interventions means that new (and more complex) populations will likely reach adulthood in the coming years.Practitioners who take care of adults with CHD are often charged with the delivery or coordination of comprehensive care for these complex patients, including the management of manifestations and complications that arise later in life. ACHD has many extra-cardiac effects, both as syndromic associations with congenital heart defects, or more commonly, as sequelae of primary structural or hemodynamic abnormalities. The role of genetic predilection remains undefined for nearly all extra-cardiac complications, though their incidence has clearly risen over the past decades. Indeed, more than a third of hospital admissions for ACHD patients are now for noncardiovascular reasons [4]. Optimal care of ACHD patients, therefore, mandates a thorough understanding of its multiorgan system manifestations. Herein, we will review current understanding of the most common manifestations of ACHD organized by the affected organ systems. Neurologic/neuropsychiatric Cerebrovascular complicationsA recent study quantified the strikingly high rates of stroke in ACHD [5]. Among nearly 30,000 ACHD patients, 8.9% of men http://dx

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Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Cited by 298 publications

References 732 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Pulmonary Embolism due to Heparin-Induced Thrombocytopenia (HIT): A Case Report of an 11-year-old Child Undergoing Scoliosis Surgery and Literature Review

Extra-cardiac manifestations of adult congenital heart disease

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