Risk factors and co-morbidities in adolescent thromboembolism are different than those in younger children

Ishola, Titilope; Kirk, Susan E.; Guffey, Danielle; Voigt, Katherine; Shah, Mona D.; Srivaths, Lakshmi

doi:10.1016/j.thromres.2016.03.021

Cited by 32 publications

(30 citation statements)

References 26 publications

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“…Among these risk factors are obesity, immobilization, surgery, catheters, thrombophilia, hormone replacement therapy, smoking, and anatomical abnormalities. According to some authors, in adolescent subjects with vascular events, between 22% and 45% are immobilized, 18–27% are under surgery, and 5-6% are treated with hormone therapy [12, 13]. These risk factors were present in the patient we described, justifying the prescription of pharmacological thromboprophylaxis, despite the FV deficiency.…”

Section: Discussionmentioning

confidence: 73%

“…The prevalence of venous and arterial thrombosis is increasing in the paediatric and adolescent population [10, 11]. Although some authors describe as idiopathic up to 37% of cases of venous thrombosis in adolescent [12], others suggest the presence of two or more vascular risk factors in 81% of the adolescents with a thrombotic event [13]. Among these risk factors are obesity, immobilization, surgery, catheters, thrombophilia, hormone replacement therapy, smoking, and anatomical abnormalities.…”

Section: Discussionmentioning

confidence: 99%

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Hip Replacement Surgery in 14-Year-Old Girl with Factor V Deficiency: Haemostatic Treatment and Thromboprophylaxis

Mingot‐Castellano

Pérez-Núñez

Baeza-Montañez

2016

Case Reports in Hematology

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Factor V (FV) is a pivotal coagulation factor present in plasma and platelets. It plays an essential role in secondary haemostasis acting as a cofactor in the prothrombinase complex, catalysing the conversion of prothrombin to thrombin. There is little evidence on the management of mayor orthopaedic surgery in paediatric or adolescents subjects with this coagulopathy and almost no information about thromboprophylaxis in these situations. We report a case of a hip replacement in a 14-year-old girl with moderate FV deficiency (0.07 IU mL−1). As haemostatic replacement, inactivated fresh frozen plasma (FFP) was transfused at doses of 600 mL (15 mL kg−1, 45 kg weight) 2 hours before surgery and then sequential FFP infusions of 250 mL (7 mL kg−1) every 12 hours for 7 days. Plasma factor VIII, von Willebrand factor antigen, and von Willebrand ristocetin cofactor were monitored to avoid supranormal levels. Since the patient was sexually mature (Marshall and Tanner stage 5) with the hormone replacement therapy, she was immobilized and the surgery was considered as a high thrombotic risk. Thus, low molecular weight heparin was administered at doses of intermediate risk (Enoxaparin 20 mg daily, by weight) after finishing the daily infusion of plasma: 24 hours and during the 7 days after intervention. No tranexamic acid was used. No haemorrhagic or thrombotic adverse event was described.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Hip Replacement Surgery in 14-Year-Old Girl with Factor V Deficiency: Haemostatic Treatment and Thromboprophylaxis

Mingot‐Castellano

Pérez-Núñez

Baeza-Montañez

2016

Case Reports in Hematology

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“…The most commonly cited putative risk factors for VTE in children are the presence of central venous catheters, malignancy, infection/sepsis, major trauma, burns, immobility, postsurgical state, congenital thrombophilias, and drugs such as parenteral nutrition, oral contraceptives, and chemotherapy . Small single institution studies have also suggested that obesity, systemic steroids, female gender, mechanical ventilation, and renal failure may also be associated with increased VTE risk.…”

Section: Discussionmentioning

confidence: 99%

Association of perioperative red blood cell transfusion with postoperative venous thromboembolism in pediatric patients: A propensity score matched analysis

Rothstein

Cairo

Schaefer

et al. 2019

Pediatric Blood & Cancer

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Objective:To examine the association between perioperative red blood cell (RBC) transfusion and postoperative venous thromboembolism (VTE) in pediatric surgical patients. Methods:Retrospective cohort study using the National Surgical Quality Improvement Project Pediatric, a validated registry of 118 United States children's hospitals. Patients under 19 years of age undergoing a surgical procedure between 2012 and 2017 were included, with the main exposure being RBC transfusion in the perioperative period (48 hours prior to operation to 72 hours after operation). The primary 30-day outcome of interest was a postoperative VTE requiring therapy. Risk-adjusted odds ratios (aOR) were calculated using multiple logistic regression. Subgroup analyses were performed across multiple surgical specialties. Sensitivity analyses were performed after (a) imputation for missing variables and (b) propensity score matching.Results: During the study years, 482 867 pediatric patients (56.7% male; median age, 6 years [interquartile range, 1-12 years]) underwent an operation. Of these, 30 879 (6.4%) received at least one perioperative RBC transfusion. Postoperative VTE requiring therapy occurred in 618 patients (0.13%). After adjustment for multiple risk factors, perioperative RBC transfusion was associated with an increased risk of VTE (aOR 2.4; 95% CI, 1.9-3.0). The increased VTE risk persisted after imputation of missing demographic and clinical data as well as after 1:1 propensity score matching (29 811 matched pairs, aOR 2.2; 95% CI, 1.7-2.8). Conclusions:Perioperative RBC transfusion is associated with an increased, albeit still very low, risk of postoperative VTE in pediatric patients. Patients receiving blood in the perioperative period may benefit from additional monitoring or VTE prophylaxis. K E Y W O R D Shematology, hemostasis, surgery, thrombosis, transfusion

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“…1,8,9 In a recent study of adolescent thromboembolism, asso- other medical conditions in 11% of patients. 10 Pediatric VTE is often a result of a combination of at least two prothrombotic risk factors. 11 Certainly, our four patients had risk factors beyond obesity, sedentary lifestyle, and prolonged video game use; however, the contribution of these prothrombotic risk factors, in addition to others (that is, FVL heterozygosity, immobilization due to illness, and autoimmune and inflammatory conditions), possibly resulted in major VTEs.…”

Section: Discussionmentioning

confidence: 99%

Obesity, sedentary lifestyle, and video games: The new thrombophilia cocktail in adolescents

Kohorst

Warad

Rao

et al. 2018

Pediatric Blood & Cancer

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Rates of venous thromboembolism have increased in the adolescent population over the last two decades, likely due to advanced diagnostics, increased use of central venous catheters, chronic medical conditions, obesity, and oral contraceptive use. Of these factors, a modifiable risk factor for adolescents is obesity. Sedentary lifestyle and prolonged immobilization are additional prothrombotic risk factors that are often associated with obesity. With ever-increasing screen time, sedentary behavior has risen accordingly, especially among gamers. We present four cases of adolescents who developed life-threatening venous thromboembolic events in the setting of obesity, sedentary lifestyle and/or immobilization, and prolonged video game use.

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Risk factors and co-morbidities in adolescent thromboembolism are different than those in younger children

Cited by 32 publications

References 26 publications

Hip Replacement Surgery in 14-Year-Old Girl with Factor V Deficiency: Haemostatic Treatment and Thromboprophylaxis

Hip Replacement Surgery in 14-Year-Old Girl with Factor V Deficiency: Haemostatic Treatment and Thromboprophylaxis

Association of perioperative red blood cell transfusion with postoperative venous thromboembolism in pediatric patients: A propensity score matched analysis

Obesity, sedentary lifestyle, and video games: The new thrombophilia cocktail in adolescents

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