Thrombolytic agents for arterial and venous thromboses in neonates

John, CM; Harkensee, Christian

doi:10.1002/14651858.cd004342

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…The approach to the management of PVT in neonates is not standardized because of the absence of solid evidence with regard to the safety and efficacy of antithrombotic therapy and current reports of favorable outcomes based on conservative management. Therefore, a majority of healthcare providers err on the side of caution and assume a watch‐and‐wait approach because treatment needs to be judiciously weighed in terms of benefit versus risk of causing harm.…”

Section: Discussionmentioning

confidence: 99%

“…Several procoagulants, anticoagulants, and proteins involved in the fibrinolytic pathway are gestational age dependent, and factor levels are approximately 50% of the adult values at birth but steadily mature beyond 6 months of age. 31 The approach to the management of PVT in neonates is not standardized because of the absence of solid evidence with regard to the safety and efficacy of antithrombotic therapy 34,35 and current reports of favorable outcomes based on conservative management. Therefore, a majority of healthcare providers err on the side of caution and assume a watch-and-wait approach because treatment needs to be judiciously weighed in terms of benefit versus risk of causing harm.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Bhatt

Patel

Butt

et al. 2018

Pediatric Blood & Cancer

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Background Neonatal portal vein thrombosis (PVT) is uncommon with potentially serious complications that may manifest in infancy and childhood. Objective The primary aim of our study was to describe the short‐term and long‐term outcomes of neonatal PVT. Methods A retrospective chart review was conducted from 2008 to 2016 of neonates diagnosed with PVT. A systematic review was also performed from 2000 to 2018 to evaluate anticoagulant therapy (ACT) in neonatal PVT. Results Forty‐four premature and 30 term infants (mean gestational age 30.7 vs 39.1 weeks, respectively) had PVT. Sixty‐eight involved the left portal vein, one involved only the main portal vein, and 5 involved ≥1 vein. PVT was catheter associated in 46 (62%); none of the 7 neonates tested had thrombophilia. Of 74 neonates, 19 (26%) received ACT and 55 (74%) were untreated. The mean follow‐up duration was 16.6 months (SD = 17.62; range, 0–89.6); 59.5% were followed for ≥6 months. On last ultrasound examination, thrombus resolution was documented in treated (ACT; n = 19) and nontreated (n = 55) neonates: 12 (63%) versus 32 (58%) with complete resolution, 1 (5%) versus 6 (11%) partial, 0 versus 1 (2%) extension, and 6 (32%) versus 16 (29%) had nonprogressive lesions, respectively. Seventy‐one (96%) had no complications. Seventy‐one articles met inclusion criteria for the systematic review and 19 were retained for analysis after assessment. Conclusions PVT resolution rate was similar to previous reports. Although a low complication rate was detected, longer follow‐up is necessary to determine the need for early treatment and the precise incidence of outcomes such as portal hypertension.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Bhatt

Patel

Butt

et al. 2018

Pediatric Blood & Cancer

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“…A recent systematic review provided no conclusions about the most appropriate treatment, as no eligible studies were found. 8 It is generally acknowledged that there is urgent need for large multicentre studies on which to base recommendations. Treatment options include anticoagulant treatment with heparin or LMWH, thrombolytic treatment or surgery.…”

Section: Discussionmentioning

confidence: 99%

Neonatal arterial thrombus mimicking congenital heart disease

Kenny

Tsai-Goodman

2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…35 36 Treatment recommendations are uncertain therefore until there are randomised controlled trials of thrombolytic treatment for RVT, as recently advocated for all forms of thrombosis in infancy. 37 …”

Section: Prothrombotic Tendenciesmentioning

confidence: 99%

Perinatal renal venous thrombosis: presenting renal length predicts outcome

Winyard¹

2006

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Background: Renal venous thrombosis (RVT) is the most common form of venous thrombosis in neonates, causing both acute and long term kidney dysfunction. Historical predisposing factors include dehydration, maternal diabetes, and umbilical catheters, but recent reports highlight associations with prothrombotic abnormalities. Study: Twenty three patients with neonatal RVT were analysed over 15 years. Predisposing factors, presentation, and procoagulant status were compared with renal outcome using multilevel modelling. Results: Median presentation was on day 1: 19/23 (83%) had pre/perinatal problems, including fetal distress (14), intrauterine growth retardation (five), and pre-identified renal abnormalities (two); 8/18 (44%) had procoagulant abnormalities, particularly factor V Leiden mutations (4/18). Long term abnormalities were detected in 28/34 (82%) affected kidneys; mean glomerular filtration rate was 93.6 versus 70.2 ml/min/1.73 m 2 in unilateral versus bilateral cases (difference 23.4; 95% confidence interval 6.4 to 40.4; p = 0.01). No correlation was observed between procoagulant tendencies and outcome, but presenting renal length had a significant negative correlation: mean fall in estimated single kidney glomerular filtration rate was 3 ml/min/1.73 m 2 (95% confidence interval 3.7 to 22.2; p = 0.001) per 1 mm increase, and kidneys larger than 6 cm at presentation never had a normal outcome. Conclusions: This subgroup of neonatal RVT would be better termed perinatal RVT to reflect antenatal and birth related antecedents. Prothrombotic defects should be considered in all patients with perinatal RVT. Kidney length at presentation correlated negatively with renal outcome. The latter, novel observation raises the question of whether larger organs should be treated more aggressively in future.

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Thrombolytic agents for arterial and venous thromboses in neonates

Cited by 4 publications

References 17 publications

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Neonatal arterial thrombus mimicking congenital heart disease

Perinatal renal venous thrombosis: presenting renal length predicts outcome

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