Prothrombotic Abnormalities in Children With Venous Thromboembolism

Bonduel, Mariana; Hepner, Mirta; Sciuccati, Gabriela; Torres, Aurora Feliú; Pieroni, Graciela; Frontroth, Juan Pablo

doi:10.1097/00043426-200001000-00013

Cited by 47 publications

(27 citation statements)

References 41 publications

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“…Platelets activated at the site of vascular damage play a role in polymorphonuclear accumulation in a growing thrombus and these leukocytes can further contribute to platelet activation and to increased fibrin deposition [25]. The consumption of protein C, protein S, and other proteins of the hemostatic system also has a role in development of thrombotic complications in patients with infection [26].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Pediatric Thrombotic Patients in Turkey

Ören

Devecioğlu

Kemahlı

et al. 2004

Pediatric Hematology and Oncology

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This study analyzes the data of thrombotic children who were followed up in different pediatric referral centers of Turkey, to obtain more general data on the diagnosis, risk factors, management, and outcome of thrombosis in Turkish children. A simple two-page questionnaire was distributed among contact people from each center to standardize data collection. Thirteen pediatric referral centers responded to the invitation and the total number of cases was 271. All children were diagnosed with thromboembolic disease between January 1995 and October 2001. Median age at time of first thrombotic event was 7.0 years. Of the children 4% of the cases were neonates, 12% were infants less than 1 year old, and 17% were adolescents. Thromboembolic event was mostly located in the cerebral vascular system (32%), deep venous system of the limbs, femoral and iliac veins (24%), portal veins (10%), and intracardiac region (9%). Acquired risk factors were present in 86% of the children. Infection was the most common underlying risk factor. Inherited risk factors were present in 30% of the children. FVL was the most common inherited risk factor. Acquired and inherited risk factors were present simultaneously in 19% of the patients. Eleven children had a history of familial thrombosis. Due to the local treatment preferences, the treatment of the children varied greatly. Outcome of the 142 patients (52%) was reported: 88 (62%) patients had complete resolution, 47 (33%) had complications, 12 (9%) had recurrent thrombosis, and 34 (24%) died. Three children (2.1%) died as a direct consequence of their thromboembolic disease. The significant morbidity and mortality found in this study supports the need for multicentric prospective clinical trials to obtain more generalizable data on management and outcome of thrombosis in Turkish children.

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Section: Discussionmentioning

confidence: 99%

Analysis of Pediatric Thrombotic Patients in Turkey

Ören

Devecioğlu

Kemahlı

et al. 2004

Pediatric Hematology and Oncology

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“…To date, the rate of single or combined prothrombotic risk factors detected in Caucasian children is approximately 50%, while no thrombophilia has been found in the remaining subjects [12, 14, 17, 36]. Data presented here give evidence that increased α 1 -AT concentrations greater than age-dependent 90th percentiles further contribute as a significant and independent risk factor to symptomatic IS in Caucasian children, in 17.3% of cases not combined with one of the established risk factors.…”

Section: Discussionmentioning

confidence: 99%

Elevated α<sub>1</sub>-Antitrypsin Is a Risk Factor for Arterial Ischemic Stroke in Childhood

Burghaus

Langer²,

Thedieck³

et al. 2006

Acta Haematol

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α₁-antitrypsin (α₁-AT) is a physiological inhibitor of activated protein C (APC) and therefore decreased APC activity. APC itself causes an anticoagulant effect by inactivating factors Va and VIIIa. The present case-control study was performed to evaluate the role of the elevated α₁-AT concentration in pediatric patients with ischemic stroke (IS). α₁-AT concentrations were measured along with established prothrombotic risk factors 6–12 months after the acute thrombotic onset in 81 Caucasian children with IS aged 1 month to 18 years. The cutoff values defined as age-dependent 90th percentiles were obtained from 229 healthy controls. Median (range) values of α₁-AT were significantly higher in patients compared with control subjects [122.0 mg/dl (61.4–224.0) vs. 114.0 mg/dl (66.8–156.0); p = 0.016]. In addition, 14 of the 81 patients (17.3%) compared with 10 of the 162 controls (6.2%) had α₁-AT concentrations above the 90th age-dependent percentiles (p = 0.012). Multivariate analysis performed in a 1:2 matched case-control setting adjusted for the presence of established prothrombotic risk factors showed a significantly increased odds ratio (OR) and 95% confidence interval (CI) for patients with elevated α₁-AT >90th percentiles and IS (OR/CI: 4.0/1.64–9.92; p = 0.0024). Data shown here give evidence that total α₁-AT concentrations above the 90th age-dependent percentiles independently increase the risk of IS 4.0-fold in Caucasian children.

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“…Evaluation should be undertaken in children with DVT in whom one or more risk factors are present. 2 Deep venous thrombosis has been reported in adults with severe head (Abbreviated Injury Scale score Ն 3), thoracic, abdominal, lower-extremity, and spinal injuries. No such relationship has been reported for severe upperextremity injuries.…”

Section: Causes Of Dvtmentioning

confidence: 99%

Deep venous thrombosis in children and adolescents

Levy

Granville²,

Hart³

et al. 2004

Journal of Neurosurgery: Pediatrics

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Children with DVT can experience serious complications in the form of both morbidity and mortality. Although most thrombotic complications have been found in patients with femoral lines, prolonged treatment involving a central line has been found to be a significant predictor of DVT. Multiple treatment modalities currently exist for children with DVT. Low-molecular-weight heparin therapy has many benefits over unfractionated heparin agents and may be more appropriate for the prophylaxis or treatment of children and adolescents with DVT because of its acceptable safety and efficacy. Clinical data for neonates and young children remain incomplete.

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Prothrombotic Abnormalities in Children With Venous Thromboembolism

Abstract: In the series, a high percentage of prothrombotic disorders was detected; thus, a complete hemostatic evaluation should be performed in all of the children with VTE whether the patients have one or more risk factors.

Cited by 47 publications

References 41 publications

Analysis of Pediatric Thrombotic Patients in Turkey

Analysis of Pediatric Thrombotic Patients in Turkey

Elevated α<sub>1</sub>-Antitrypsin Is a Risk Factor for Arterial Ischemic Stroke in Childhood

Deep venous thrombosis in children and adolescents

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