MANAGEMENT OF PEDIATRIC THROMBOSIS IN A SINGLE TERTIARY CARE MEDICAL CENTER
(Abstract release date: 05/19/16)
EHA Library. Yus Cebrian F. 06/09/16; 135106; PB2206
Dr. Flor Yus Cebrian
Contributions
Contributions
Abstract
Abstract: PB2206
Type: Publication Only
Background
Venous and arterial thrombosis is increasingly encountered in the pediatric population.
Aims
The aim of this retrospective study was to summarize our experience regarding clinical characteristics, diagnosis and management of pediatric thrombosis in a single tertiary care medical center.
Methods
We reviewed clinical files of patients (pts) under 18 years old diagnosed of arterial thrombosis (AT) and/or venous thromboembolic (VTE) events in our institution between March 2006 and June 2015. Clinical data, thrombotic risk factors (TRF), thrombophilia test results, thrombosis location and therapy were analized.
Results
49 AT and/or VTE events were diagnosed in 48 pts, median age at diagnosis was 1 year (0-17); 24 pts were infants (25% neonates) and 24 (50%) >1year; out of 48 pts, 29 were ♂ and 19 ♀. Clinical presentation: arterial isquemic stroke 19 (38.7%), lower extremities deep venous thrombosis (DVT) 13 (26.6%), cerebral venous sinus thrombosis 8 (16.3%), portal and inferior vena cava thrombosis 4 (8.2%), lower extremity arterial ischemia 2 (4.08%), purpura fulminans 1 (2.04%), subclavian vein thrombosis 1 (2.04%) and suprahepatic vein thrombosis 1 (2.04%). Age classification of pts was: 18 (37.5%) newborns: <1 month; 6 (12.5%) infants: < 1 year, 12 (25%) children: 1-13 years and 12 (25%) adolescents: 14-17 years. According to the age classification the most common clinical presentations were arterial isquemic stroke in newborns 12 (66.6%); DVT 2 (33%) and portal/ inferior vena cava thrombosis 2 (33%) in infants; cerebral sinus thrombosis 4 (30%) in children and DVT 6 (50%) in adolescents.Adquired risk factors included systemic sepsis and oncologic diseases in 15 and 6 pts, 4 central venous catheter carriers, 3 congenital heart disease (CHD), 2 systemic sepsis + CHD, 4 artery malformations, 1 immobilization after ankle injury, 1 hormonal contraceptives therapy + sepsis, and 1 perinatal hypoxic-ischemic encephalopathy. The most important risk factor for thrombosis was systemic sepsis. In 12 cases no risk factors for thrombosis were found. Thrombophilia testing was performed in 36 cases (73.4%). Thrombophilic risk factors were found in 9 pts 25%: 2 prothrombin G20210A mutation, 1 prothrombin G20210A + MTHFR mutations, 1 R506Q mutation, 1 Protein S decreased, 1 lupus anticoagulant, 1 Protein S decreased + lupus anticoagulant and 1 antiphospholipid-like syndrome. Anticoagulation therapy was initiated in 3 pts with unfractioned heparin to achieve therapeutic aPTT and 30 pts received enoxaparin at a mean dose of 1 mg/kg/12 h to achieve anti-Xa therapeutic level. Median duration of anticoagulation was 3 months. Median number of anti-Xa level was 6.96 (1-22), and range controls 4.61 (0-19). Intraarterial fibrinolytic therapy followed by enoxaparin was administered in 1 pt with stroke, 4 pts with stroke were antiaggregated with AAS. No anticoagulation/ antiaggregation was given to 15 pts. Overall recurrence rate of thrombosis was 6.2% (3/48); mortality rate 4.1% (2/48). Mortality was related to underlying diseases: 1 pt perinatal hypoxic encephalopathy and 1 pt tumor progression. Gastrointestinal bleeding linked to anticoagulation was observed in 1 pt.
Conclusion
The distribution of thrombosis was similar to already published. Acquired thrombotic risk factors were associated with both AT and VTE. We must be cautious about interpretation of thrombophilia test because the haemostatic system is still developing. Adjustment in enoxaparin dosage to target anti-Xa level is a valuable tool for anticoagulant therapy in pediatric thrombosis.
Session topic: E-poster
Keyword(s): Enoxaparin, Thrombosis
Type: Publication Only
Background
Venous and arterial thrombosis is increasingly encountered in the pediatric population.
Aims
The aim of this retrospective study was to summarize our experience regarding clinical characteristics, diagnosis and management of pediatric thrombosis in a single tertiary care medical center.
Methods
We reviewed clinical files of patients (pts) under 18 years old diagnosed of arterial thrombosis (AT) and/or venous thromboembolic (VTE) events in our institution between March 2006 and June 2015. Clinical data, thrombotic risk factors (TRF), thrombophilia test results, thrombosis location and therapy were analized.
Results
49 AT and/or VTE events were diagnosed in 48 pts, median age at diagnosis was 1 year (0-17); 24 pts were infants (25% neonates) and 24 (50%) >1year; out of 48 pts, 29 were ♂ and 19 ♀. Clinical presentation: arterial isquemic stroke 19 (38.7%), lower extremities deep venous thrombosis (DVT) 13 (26.6%), cerebral venous sinus thrombosis 8 (16.3%), portal and inferior vena cava thrombosis 4 (8.2%), lower extremity arterial ischemia 2 (4.08%), purpura fulminans 1 (2.04%), subclavian vein thrombosis 1 (2.04%) and suprahepatic vein thrombosis 1 (2.04%). Age classification of pts was: 18 (37.5%) newborns: <1 month; 6 (12.5%) infants: < 1 year, 12 (25%) children: 1-13 years and 12 (25%) adolescents: 14-17 years. According to the age classification the most common clinical presentations were arterial isquemic stroke in newborns 12 (66.6%); DVT 2 (33%) and portal/ inferior vena cava thrombosis 2 (33%) in infants; cerebral sinus thrombosis 4 (30%) in children and DVT 6 (50%) in adolescents.Adquired risk factors included systemic sepsis and oncologic diseases in 15 and 6 pts, 4 central venous catheter carriers, 3 congenital heart disease (CHD), 2 systemic sepsis + CHD, 4 artery malformations, 1 immobilization after ankle injury, 1 hormonal contraceptives therapy + sepsis, and 1 perinatal hypoxic-ischemic encephalopathy. The most important risk factor for thrombosis was systemic sepsis. In 12 cases no risk factors for thrombosis were found. Thrombophilia testing was performed in 36 cases (73.4%). Thrombophilic risk factors were found in 9 pts 25%: 2 prothrombin G20210A mutation, 1 prothrombin G20210A + MTHFR mutations, 1 R506Q mutation, 1 Protein S decreased, 1 lupus anticoagulant, 1 Protein S decreased + lupus anticoagulant and 1 antiphospholipid-like syndrome. Anticoagulation therapy was initiated in 3 pts with unfractioned heparin to achieve therapeutic aPTT and 30 pts received enoxaparin at a mean dose of 1 mg/kg/12 h to achieve anti-Xa therapeutic level. Median duration of anticoagulation was 3 months. Median number of anti-Xa level was 6.96 (1-22), and range controls 4.61 (0-19). Intraarterial fibrinolytic therapy followed by enoxaparin was administered in 1 pt with stroke, 4 pts with stroke were antiaggregated with AAS. No anticoagulation/ antiaggregation was given to 15 pts. Overall recurrence rate of thrombosis was 6.2% (3/48); mortality rate 4.1% (2/48). Mortality was related to underlying diseases: 1 pt perinatal hypoxic encephalopathy and 1 pt tumor progression. Gastrointestinal bleeding linked to anticoagulation was observed in 1 pt.
Conclusion
The distribution of thrombosis was similar to already published. Acquired thrombotic risk factors were associated with both AT and VTE. We must be cautious about interpretation of thrombophilia test because the haemostatic system is still developing. Adjustment in enoxaparin dosage to target anti-Xa level is a valuable tool for anticoagulant therapy in pediatric thrombosis.
Session topic: E-poster
Keyword(s): Enoxaparin, Thrombosis
Abstract: PB2206
Type: Publication Only
Background
Venous and arterial thrombosis is increasingly encountered in the pediatric population.
Aims
The aim of this retrospective study was to summarize our experience regarding clinical characteristics, diagnosis and management of pediatric thrombosis in a single tertiary care medical center.
Methods
We reviewed clinical files of patients (pts) under 18 years old diagnosed of arterial thrombosis (AT) and/or venous thromboembolic (VTE) events in our institution between March 2006 and June 2015. Clinical data, thrombotic risk factors (TRF), thrombophilia test results, thrombosis location and therapy were analized.
Results
49 AT and/or VTE events were diagnosed in 48 pts, median age at diagnosis was 1 year (0-17); 24 pts were infants (25% neonates) and 24 (50%) >1year; out of 48 pts, 29 were ♂ and 19 ♀. Clinical presentation: arterial isquemic stroke 19 (38.7%), lower extremities deep venous thrombosis (DVT) 13 (26.6%), cerebral venous sinus thrombosis 8 (16.3%), portal and inferior vena cava thrombosis 4 (8.2%), lower extremity arterial ischemia 2 (4.08%), purpura fulminans 1 (2.04%), subclavian vein thrombosis 1 (2.04%) and suprahepatic vein thrombosis 1 (2.04%). Age classification of pts was: 18 (37.5%) newborns: <1 month; 6 (12.5%) infants: < 1 year, 12 (25%) children: 1-13 years and 12 (25%) adolescents: 14-17 years. According to the age classification the most common clinical presentations were arterial isquemic stroke in newborns 12 (66.6%); DVT 2 (33%) and portal/ inferior vena cava thrombosis 2 (33%) in infants; cerebral sinus thrombosis 4 (30%) in children and DVT 6 (50%) in adolescents.Adquired risk factors included systemic sepsis and oncologic diseases in 15 and 6 pts, 4 central venous catheter carriers, 3 congenital heart disease (CHD), 2 systemic sepsis + CHD, 4 artery malformations, 1 immobilization after ankle injury, 1 hormonal contraceptives therapy + sepsis, and 1 perinatal hypoxic-ischemic encephalopathy. The most important risk factor for thrombosis was systemic sepsis. In 12 cases no risk factors for thrombosis were found. Thrombophilia testing was performed in 36 cases (73.4%). Thrombophilic risk factors were found in 9 pts 25%: 2 prothrombin G20210A mutation, 1 prothrombin G20210A + MTHFR mutations, 1 R506Q mutation, 1 Protein S decreased, 1 lupus anticoagulant, 1 Protein S decreased + lupus anticoagulant and 1 antiphospholipid-like syndrome. Anticoagulation therapy was initiated in 3 pts with unfractioned heparin to achieve therapeutic aPTT and 30 pts received enoxaparin at a mean dose of 1 mg/kg/12 h to achieve anti-Xa therapeutic level. Median duration of anticoagulation was 3 months. Median number of anti-Xa level was 6.96 (1-22), and range controls 4.61 (0-19). Intraarterial fibrinolytic therapy followed by enoxaparin was administered in 1 pt with stroke, 4 pts with stroke were antiaggregated with AAS. No anticoagulation/ antiaggregation was given to 15 pts. Overall recurrence rate of thrombosis was 6.2% (3/48); mortality rate 4.1% (2/48). Mortality was related to underlying diseases: 1 pt perinatal hypoxic encephalopathy and 1 pt tumor progression. Gastrointestinal bleeding linked to anticoagulation was observed in 1 pt.
Conclusion
The distribution of thrombosis was similar to already published. Acquired thrombotic risk factors were associated with both AT and VTE. We must be cautious about interpretation of thrombophilia test because the haemostatic system is still developing. Adjustment in enoxaparin dosage to target anti-Xa level is a valuable tool for anticoagulant therapy in pediatric thrombosis.
Session topic: E-poster
Keyword(s): Enoxaparin, Thrombosis
Type: Publication Only
Background
Venous and arterial thrombosis is increasingly encountered in the pediatric population.
Aims
The aim of this retrospective study was to summarize our experience regarding clinical characteristics, diagnosis and management of pediatric thrombosis in a single tertiary care medical center.
Methods
We reviewed clinical files of patients (pts) under 18 years old diagnosed of arterial thrombosis (AT) and/or venous thromboembolic (VTE) events in our institution between March 2006 and June 2015. Clinical data, thrombotic risk factors (TRF), thrombophilia test results, thrombosis location and therapy were analized.
Results
49 AT and/or VTE events were diagnosed in 48 pts, median age at diagnosis was 1 year (0-17); 24 pts were infants (25% neonates) and 24 (50%) >1year; out of 48 pts, 29 were ♂ and 19 ♀. Clinical presentation: arterial isquemic stroke 19 (38.7%), lower extremities deep venous thrombosis (DVT) 13 (26.6%), cerebral venous sinus thrombosis 8 (16.3%), portal and inferior vena cava thrombosis 4 (8.2%), lower extremity arterial ischemia 2 (4.08%), purpura fulminans 1 (2.04%), subclavian vein thrombosis 1 (2.04%) and suprahepatic vein thrombosis 1 (2.04%). Age classification of pts was: 18 (37.5%) newborns: <1 month; 6 (12.5%) infants: < 1 year, 12 (25%) children: 1-13 years and 12 (25%) adolescents: 14-17 years. According to the age classification the most common clinical presentations were arterial isquemic stroke in newborns 12 (66.6%); DVT 2 (33%) and portal/ inferior vena cava thrombosis 2 (33%) in infants; cerebral sinus thrombosis 4 (30%) in children and DVT 6 (50%) in adolescents.Adquired risk factors included systemic sepsis and oncologic diseases in 15 and 6 pts, 4 central venous catheter carriers, 3 congenital heart disease (CHD), 2 systemic sepsis + CHD, 4 artery malformations, 1 immobilization after ankle injury, 1 hormonal contraceptives therapy + sepsis, and 1 perinatal hypoxic-ischemic encephalopathy. The most important risk factor for thrombosis was systemic sepsis. In 12 cases no risk factors for thrombosis were found. Thrombophilia testing was performed in 36 cases (73.4%). Thrombophilic risk factors were found in 9 pts 25%: 2 prothrombin G20210A mutation, 1 prothrombin G20210A + MTHFR mutations, 1 R506Q mutation, 1 Protein S decreased, 1 lupus anticoagulant, 1 Protein S decreased + lupus anticoagulant and 1 antiphospholipid-like syndrome. Anticoagulation therapy was initiated in 3 pts with unfractioned heparin to achieve therapeutic aPTT and 30 pts received enoxaparin at a mean dose of 1 mg/kg/12 h to achieve anti-Xa therapeutic level. Median duration of anticoagulation was 3 months. Median number of anti-Xa level was 6.96 (1-22), and range controls 4.61 (0-19). Intraarterial fibrinolytic therapy followed by enoxaparin was administered in 1 pt with stroke, 4 pts with stroke were antiaggregated with AAS. No anticoagulation/ antiaggregation was given to 15 pts. Overall recurrence rate of thrombosis was 6.2% (3/48); mortality rate 4.1% (2/48). Mortality was related to underlying diseases: 1 pt perinatal hypoxic encephalopathy and 1 pt tumor progression. Gastrointestinal bleeding linked to anticoagulation was observed in 1 pt.
Conclusion
The distribution of thrombosis was similar to already published. Acquired thrombotic risk factors were associated with both AT and VTE. We must be cautious about interpretation of thrombophilia test because the haemostatic system is still developing. Adjustment in enoxaparin dosage to target anti-Xa level is a valuable tool for anticoagulant therapy in pediatric thrombosis.
Session topic: E-poster
Keyword(s): Enoxaparin, Thrombosis
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