Thrombosis in Infants and Children

Schneppenheim, Reinhard; Greiner, Jeanette

doi:10.1182/asheducation-2006.1.86

Cited by 31 publications

(34 citation statements)

References 64 publications

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“…Although an extensive laboratory search for a prothrombotic disorder is controversial, 17,18,86,96 it is our opinion that the weight of evidence 1-4,6,9,22 -24,30-37,62,97-101 supports a step-wise thrombophilia investigation in the presence of a clinically significant postnatal thromboembolic event, regardless of the 109 number of other predisposing risk factors (Tables 3 and 4). The protein-based assays (Tables 3 and 4) are affected by the thrombotic event and must be repeated at 3 to 6 months of life before a definitive diagnosis can be made.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…Genetic mutations that result in deficiencies in antithrombin production may increase the risk for TE. 109 Elevations in the production of factors VIII, IX and XI have been reported and implicated in the development of thromboses. 109,112,113 Although elevations in lipoprotein-a concentrations have been found to increase risk for both venous and arterial thromboses in the German population, 33,34 applying this generalization to all populations remains unclear.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…Genetic mutations that result in quantitative or qualitative deficiencies of either protein C or protein S may contribute to an increase in venous TE. 35,109 Antithrombin, when bound to heparin sulfate, inhibits thrombin and activated factors XI, IX and X. Genetic mutations that result in deficiencies in antithrombin production may increase the risk for TE.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…97,110 Currently, prospective clinical trials of vitamin therapy seek to determine if hyperhomocysteinemia is a risk factor for atherothrombosis. 109,110 Thus, the MTHFR gene mutation and the risk of pediatric thrombosis remain controversial. 36,111 The protein C system contains protein C, with protein S and factor V as cofactors.…”

Section: Venous Thrombosismentioning

confidence: 99%

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The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

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Section: Venous Thrombosismentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

Section: Venous Thrombosismentioning

confidence: 99%

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The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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“…1,2 Raffini et al 3 reported an annual increase in the incidence of venous thromboembolism in pediatric hospitals of 70%. Central venous catheters are a main cause of thrombosis in children (incidence up to 70%), 4 as are underlying sepsis, cancer, heart disease, immobilization, and medications (eg, abstract Descending iliofemoral thrombosis in children is a rare event. Anticoagulation therapy with low-molecular-weight-heparin is standard of care.…”

mentioning

confidence: 99%

Ultrasound Assisted Endovascular Thrombolysis in Adolescents: 2 Case Reports

Olivieri¹,

Kurnik²,

Hoffmann

et al. 2016

Pediatrics

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Descending iliofemoral thrombosis in children is a rare event. Anticoagulation therapy with low-molecular-weight-heparin is standard of care. However, patency cannot be achieved in all cases, increasing the risk for rethrombosis and postthrombotic syndrome. To reduce the risk of venous valve failure in adults, local catheter-directed thrombolysis is used to reopen vessels. Two adolescent girls (17 and 15 years old) presented with acute descending iliofemoral thrombosis of the left common iliac, external, and common femoral veins. Anticoagulation with enoxaparin was started until insertion of an EkoSonic Mach 4e catheter for ultrasound-assisted local thrombolysis with recombinant tissue plasminogen activator and administration of unfractionated heparin. Success was monitored by increases in D-dimer levels and ultrasound findings. After 24 hours respectively 48 hours, complete recanalization was obtained. No complication occurred except minimal local bleeding. Screening for hereditary thrombophilia revealed a heterozygous antithrombin mutation in 1 girl (ie, the 15-year-old). May-Thurner syndrome was identified in both girls, necessitating stenting of the left common iliac veins and continuation of anticoagulation therapy with enoxaparin and acetylsalicylic acid. No rethrombosis or complications occurred during the follow-up period. Ultrasound-assisted catheter-directed local thrombolysis with the EkoSonic Mach 4e system was effective in achieving immediate recanalization of the occluded veins and should be considered in children experiencing descending iliofemoral thrombosis. The fast recanalization might reduce the incidence of postthrombotic syndrome. May-Thurner syndrome is regularly found in these patients, and if present, requires stenting of the common iliac vein to avoid early reocclusion. However, long-term patency of iliac vein stenting in children remains to be examined.

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Ornithine transcarbamylase deficiency: A possible risk factor for thrombosis

Venkateswaran

Scaglia

Mclin

et al. 2009

Pediatric Blood & Cancer

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Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle defect. Thromboembolic complications have not heretofore been linked with this diagnosis. We describe four patients with neonatal-onset OTC deficiency who developed vascular thromboses. One patient had arterial thrombosis; the rest developed venous thromboses. Multiple pro-thrombotic risk factors were identified. Low plasma arginine levels were observed in all patients at the time of thrombosis. Arginine deficiency and the resultant nitric oxide insufficiency may contribute to thrombotic risk. Careful normalization of plasma arginine and citrulline levels and increased surveillance for thrombotic complications should be considered in patients with OTC deficiency.

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Thrombosis in Infants and Children

Cited by 31 publications

References 64 publications

The evaluation and management of postnatal thromboses

The evaluation and management of postnatal thromboses

Ultrasound Assisted Endovascular Thrombolysis in Adolescents: 2 Case Reports

Ornithine transcarbamylase deficiency: A possible risk factor for thrombosis

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