scholarly journals How I treat pediatric venous thromboembolism

Blood ◽  
2017 ◽  
Vol 130 (12) ◽  
pp. 1402-1408 ◽  
Author(s):  
Guy Young
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Large Scale ◽  
Central Venous Catheters ◽  
Rare Disorder ◽  
Central Venous ◽  
Management Decisions ◽  
Logical Approach ◽  
The Past ◽  
Medical Disorders

Abstract The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly over the past decade in part as a result of increased recognition of this serious disorder but more so because of the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking, considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, in comparison with adults, this remains a relatively rare disorder, and as such, large-scale clinical trials have not been completed, rendering management decisions to be based on extrapolation from adult data and the experience of the treating physician. Clearly, both are fraught with problems. Thus, day-to-day management remains more art than science until such time that the results from clinical trials (many of which are under way) become available. This edition of “How I Treat” describes the author’s experience in managing 3 common scenarios that one may encounter in pediatric thrombosis and suggests a logical approach to such situations. Furthermore, the author provides 3 algorithms to help guide management decisions.

Venous Thromboembolism in the Hematologic Malignancies

2009 ◽  
Vol 27 (29) ◽  
pp. 4848-4857 ◽  
Author(s):  
Anna Falanga ◽  
Marina Marchetti
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Best Practice ◽  
Randomized Clinical Trials ◽  
Neoplastic Transformation ◽  
Hematologic Malignancies ◽  
Central Venous ◽  
Hemorrhagic Complications

Patients with hematologic malignancies are at high risk of thrombotic or hemorrhagic complications. The incidence of these events is greatly variable and is influenced by many factors, including the type of disease, the type of chemotherapy, and the use of a central venous device. As in solid tumors, a number of clinical risk factors have been identified and contribute to the increasing thrombotic rate in hematologic malignancies. Biologic properties of the tumor cells can influence the hypercoagulable state of patients with these malignancies by several mechanisms. Of interest, oncogenes responsible for neoplastic transformation in leukemia also may be involved in clotting activation. Epidemiologic data allow an estimate of the incidence of venous thromboembolism (VTE) in acute leukemia, lymphomas, and multiple myeloma (MM). In this review, we focus on the epidemiology, pathogenesis, and VTE management in these three hematologic malignancies. No recommendation for routine thromboprophylaxis in these conditions, with the exception of MM, is available. Large, prospective, randomized clinical trials are needed to establish the best practice for thromboprophylaxis and treatment of VTE in these types of cancers.

Incidence of catheter-related venous thromboembolism in peripherally inserted central venous catheters vs tunneled chest central venous catheters in patients with hematologic malignancies.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e20684-e20684
Author(s):  
Thomas A. Giever ◽  
Emily R. Giever ◽  
Patrick C. Foy ◽  
Lisa Baumann-Kreuziger ◽  
Laura C. Michaelis ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hematologic Malignancies ◽  
Central Venous Catheters ◽  
Central Venous

Impact of number of lumens in central-venous catheters on central-line bloodstream infection (CLABSI) and venous thromboembolism (VTE) risk in patients with acute leukemia

2021 ◽  
pp. 1-3
Author(s):  
Alina Varabyeva ◽  
Christabel Pui-See Lo ◽  
Adamo Brancaccio ◽  
Anthony J. Perissinotti ◽  
Twisha Patel ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Venous Thromboembolism ◽  
Acute Leukemia ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Catheters ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Central Venous ◽  
Double Lumen

Abstract This retrospective study was conducted to determine whether the number of peripherally inserted central-catheter lumens affected the rate of central-line associated bloodstream infections (CLABSIs) in adult patients with acute leukemia. The results show that CLABSI rates were not significantly different between patients with triple-lumen or double-lumen PICCs (22.1% vs 23.4%; P = .827).

Increased Incidence of Venous Thromboembolism Following Allogeneic Compared with Autologous Hematopoietic Stem Cell Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3986-3986
Author(s):  
Andrew Gonsalves ◽  
Marc Carrier ◽  
Philip Wells ◽  
Sheryl McDiarmid ◽  
Lothar Huebsch ◽  
...  
Keyword(s):  
Stem Cell ◽  
Venous Thromboembolism ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Hematopoietic Stem ◽  
Increased Risk

Abstract Background: The incidence of venous thromboembolism (VTE) following hematopoietic stem cell transplantation (HSCT) is not well described, particularly with the emerging trend towards increased ambulatory care in the transplant setting. HSCT involves high dose chemotherapy and/or radiation and is often associated with periods of immobilization. In addition, vascular damage and inflammation are common following transplantation and may further increase the risk of VTE. We sought to quantify the incidence of VTE in both allogeneic and autologous HSCT recipients and characterize the factors influencing these events. Methods: A retrospective analysis involving 589 patients (382 autologous, 207 allogeneic recipients undergoing transplantation between 2000–2005) was performed in order to identify the incidence of symptomatic acute deep proximal vein thrombosis (DVT) or pulmonary embolism (PE) in HSCT recipients. Only patients who provided signed informed consent regarding the utilization of their medical information for research purposes were included. All diagnostic imaging reports of CT pulmonary angiography, ventilation / perfusion (VQ) scanning and duplex ultrasound of the upper and lower extremities performed within the first year after HSCT were reviewed. A diagnosis of VTE was confirmed by reviewing the clinical record and verifying a moderate to high pre-test probability according to the Wells’ criteria. Non-catheter related events were the designated primary outcome. Symptomatic catheter-related events (superficial and deep veins) were secondary outcomes. Statistical analysis included comparison of mean values using Student’s t test and comparison of proportions using the chi squared analysis. Results: A total of 7 patients developed VTE following HSCT unrelated to central venous catheters (4 PE and 3 DVT) for an incidence of 1.2%. A total of 5 patients had VTE events in the allogeneic group (2.4%) and 2 autologous recipients suffered VTE events (0.52%, p=0.043). An increased number of PEs occurred in the allogeneic group compared with autologous recipients (4 vs 0, p=0.006). Symptomatic catheter-related thrombosis (superficial and deep venous occlusion combined) was not different between the allogeneic and autologous groups (7.25% vs. 5.50%, p= 0.4). Three allogeneic recipients (60%) had GVHD at the time of VTE diagnosis and only 1 patient had relapsing disease (20%) while both patients in the autologous cohort (100%) had progression of their disease at the time of VTE diagnosis. All VTE events unrelated to central venous catheters occurred after hematopoietic engraftment with a trend towards earlier occurrence in the allogeneic setting compared to autologous recipients (mean 153 days vs. 312 days, respectively, p=0.080). The mean platelet count at the time of VTE was 121 (50–174). Conclusion: HSCT patients have a high incidence of non-catheter related VTE compared to historical reports of the general and cancer populations. Allogeneic recipients have an increased risk of VTE and of PE in comparison to autologous transplant patients. VTE occurred exclusively in HSCT patients after hematopoietic recovery. Perhaps thrombocytopenia and the emphasis on ambulatory patient status in our program were protective against the development of VTE. Our study supports the notion that GVHD may contribute to the development of VTE in allogeneic transplant recipients. Moreover, progression of the underlying malignancy may be a dominant risk factor in the development of VTE in autologous recipients.

scholarly journals Convalescent Plasma Therapy: a Possible Treatment of COVID-19 Pandemic

2020 ◽  
Vol 2 (2) ◽  
pp. 45-47
Author(s):  
Shubha Devi Sapkota ◽  
Monika Sharma ◽  
Gehendra Bhusal
Keyword(s):  
Infectious Disease ◽  
Clinical Trials ◽  
Severe Acute Respiratory Syndrome ◽  
Large Scale ◽  
Alternative Therapy ◽  
Lung Damage ◽  
Plasma Therapy ◽  
The Past ◽  
Wide Range ◽  
Severe Infections

COVID 19 is a newly recognized infectious disease that has rapidly spread with no verified treatment available. It is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2). In Convalescent plasma therapy, the yellowish liquid or the plasma from the recovered blood is used to treat the patient suffering from the same illness. For more than 100 years it has been used to treat severe infections with varying degrees of success. For this present infection, multiple clinical trials on plasma therapy are still under vigorous investigations. Despite the very low chance of risks like allergies, lung damage, and transmission of blood-related infection, the therapy has shown a positive result in the recovery of the patients. Many experts are observing its use as a “stopgap measure” until effective vaccines and antiviral drugs are available in a wide range. However, the main challenges faced are finding suitable donors, its expensiveness in the whole procedure, and inability to perform on a large scale. In this commentary, summarization of the convalescent plasma therapy is done as a hopeful alternative therapy of severe or critical COVID 19. It has also emphasized the promising results shown since the past while the use of this therapy in various infectious diseases.

Use of intravenously administered lipid in neonates

PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 5-7
Author(s):  
William C. Heird ◽  
John M. Driscoll
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Unique Feature ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Current Application ◽  
Intrauterine Growth ◽  
The Past ◽  
Interesting Paper ◽  
Per Se

In this month's Pediatrics another method for feeding small infants is described. Although the method per se (i.e., intravenous supplementation of tolerated oral feedings) has been used frequently over the past few years, the present application is the first by which intrauterine growth rates with respect to weight, height, and head circumference have been achieved. The unique feature of the current application of the method is inclusion of an intravenously administered fat preparation as part of the nutrient infusate. The impressive growth rates were achieved without the use of central venous catheters with their attendant complications and without the use of indwelling intragastric or intraintestinal tubes. Several aspects of this interesting paper require comment. First, despite the fact that achievement of intrauterine growth rates postnatally has been the goal of neonatologists for a number of years, such a growth rate has never been shown to be beneficial. In fact, it can be argued that infants who are gaining weight, regardless of how slowly, are receiving adequate nutrients to meet on-going metabolic requirements and are not undergoing a net breakdown of endogenous nutrient stores. Furthermore, a number of changes in body composition (e.g., loss of body water) occur postnatally and these changes make a continued intrauterine growth rate almost impossible out major changes in metabolism and/or metabolic requirements. Moreover, most of the weight increase during the last trimester is fat which, perhaps beneficial before birth, may actually be detrimental when deposited postnatally. The appropriateness of a continued intrauterme growth rate is particularly pertinent when it is achieved with an agent that has not been evaluated thoroughly in very small infants (i.e., an intravenous soybean oil [Intralipid]).

scholarly journals Clinical Trials: New Developments

2000 ◽  
Vol 7 (6) ◽  
pp. 443-443
Author(s):  
Louis-Philippe Boulet
Keyword(s):  
Clinical Trials ◽  
Health Research ◽  
Large Scale ◽  
Respiratory Health ◽  
Collaborative Activity ◽  
New Developments ◽  
The Past ◽  
International Projects

Canadian respiratory health research is recognized as being among the best worldwide. Many Canadian researchers are leaders in international projects, including large scale clinical trials. There is, however, a need to develop a structure that could foster the collaboration of Canadian investigators in joint projects of this sort. In the past few years, discussions have taken place on what could be a Canadian Thoracic Society (CTS) Clinical Trials Group. This is a wonderful opportunity to put forward such an initiative, in the context of the new Canadian Institutes of Health Research (CIHR), where this type of collaborative activity fits quite well with the goals of this new institution.

Venous Thromboembolism Associated With Long-Term Use of Central Venous Catheters in Cancer Patients

2003 ◽  
Vol 21 (19) ◽  
pp. 3665-3675 ◽  
Author(s):  
Melina Verso ◽  
Giancarlo Agnelli
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Central Venous Catheters ◽  
Fixed Dose ◽  
Venous Stasis ◽  
Low Molecular Weight ◽  
Central Venous ◽  
Vessel Injury ◽  
Recommended Therapy

Long-term central venous catheters (CVCs) have considerably improved the management of cancer patients because they facilitate chemotherapy, transfusions, parenteral nutrition, and blood sampling. However, the use of long-term CVCs, especially for chemotherapy, has been associated with the occurrence of upper-limb deep venous thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to CVCs has been reported to vary between 0.3% and 28.3%. The incidence of CVC-related UL-DVT screened by venography reportedly varies between 27% and 66%. The incidence of clinically overt pulmonary embolism (PE) in patients with CVC-related UL-DVT ranges from 15% to 25%, but an autopsy-proven PE rate of up to 50% has been reported. Vessel injury caused by the procedure of CVC insertion, venous stasis caused by the indwelling CVC, and cancer-related hypercoagulability are the main pathogenetic factors for CVC-related venous thromboembolism (VTE). Several studies have assessed the benefit of the prophylaxis of UL-DVT after CVC insertion in cancer patients. According to the results of these studies, prophylaxis with low molecular weight heparin or a low fixed dose of warfarin has been recently proposed. However, the limitations of the experimental design of the prophylactic studies do not allow definitive recommendations. The recommended therapy for UL-DVT associated with CVC is based on anticoagulant therapy with or without catheter removal. This review focuses on the epidemiology, pathogenesis, diagnosis, prevention, and treatment of VTE in cancer patients with long-term CVC.

Sign in / Sign up

Export Citation Format

Share Document