Thromboembolism in children with cancer: a retrospective multicenter study in Korea

Elevated Risk of Venous Thromboembolism in People Living with HIV

Human immunodeficiency virus (HIV) has been generally considered as a highly adaptive and rapidly evolving virus. It still constitutes a major public health problem all over the world despite an effective outcome in the prevention and reversal of the development and prognosis by using antiretroviral therapy. The salient question lies in the more frequent emergence of a series of comorbidities along with the prolongation of the life, which deeply affects the survival in such group. Venous thromboembolism (VTE) has been recognized to be the third most common cardiovascular condition within people living with HIV (PWH). In terms of its mechanism of action, the occurrence of VTE is quite multifactorial and complex in HIV. Prior exploration concerning the etiology of VTE in PWH identifies general, disease-specific, and miscellaneous factors for explaining its occurrence and development. VTE has constituted an important role in PWH and may increase its all-cause mortality. Therefore, it is quite necessary to understand VTE from the following aspects of epidemiology, pathophysiology, molecular mechanisms, and therapeutic interventions so as to balance the risks and benefits of anticoagulation and optimize corresponding treatment.

Risk for deep venous thrombosis in pediatric cancer patients undergoing surgery

PURPOSE

Cancer is a well-established risk factor for deep venous thrombosis (DVT). We sought to assess the incidence of DVT in pediatric cancer patients undergoing select surgical procedures at our institution and to identify additional factors associated with DVT development.

METHODS

We performed a retrospective review of cancer patients who underwent select surgical procedures and developed a DVT within 30 days of their operation from 2000 to 2018 at our institution. Catheter-associated DVTs were excluded from this analysis. Major oncologic operations were selected.

RESULTS

From 2000 to 2018, 3031 major oncologic operations were performed following which 14 symptomatic DVTs occurred, for an overall incidence of 0.46%. Procedures associated with post-operative DVT included: mass biopsy (7), pulmonary wedge resection (2), inguinal lymph node excision (1), colectomy (1), nephrectomy (1), lower extremity limb-sparing revision (1), and femur resection (1).

CONCLUSIONS

Our data suggest that surgery does not put children with cancer at significant risk for DVT. Given the low incidence of perioperative DVT, routine pharmacologic prophylaxis for children with cancer undergoing surgery does not seem warranted.

LEVEL OF EVIDENCE

II.

Prevention of Venous Thromboembolism in 2020 and Beyond

Venous thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). In this review, we discuss how an understanding of VTE epidemiology and the results of thromboprophylaxis trials have shaped the current approach to VTE prevention. We will discuss modern thromboprophylaxis as it pertains to genetic risk factors, exogenous hormonal therapies, pregnancy, surgery, medical hospitalization, cancer, and what is known thus far about VTE in COVID-19 infection.

Venous Thromboembolism in Children and Young Adults in Korea: Analysis of the Korean Health Insurance Review and Assessment Service Database

BACKGROUND

Venous thromboembolism (VTE) is very rare in childhood. Nevertheless, its incidence has increased recently. This study aimed to identify risk factors for developing thrombosis in childhood cancers and other childhood diseases through the Korean Health Insurance Review and Assessment Service database.

METHODS

Data were extracted from the Korean Health Insurance Review and Assessment Service database. Children and young adults from 1 month to 29 years of age were eligible, and 21,747 cases of VTE between January 2008 and December 2016 were identified.

RESULTS

The VTE incidence was high in children younger than 1 year of age. After 1 year of age, its incidence decreased rapidly and gradually increased. The VTE incidence for children between 0 and 1 year of age was 10.23-fold higher than that for those between 1 and 5 years of age. Annual VTE incidence increased by year. The age-standardized annual incidence rates were 9.98 per 100,000 population in 2008 and 22.53 per 100,000 population in 2016. The age-standardized annual incidence rate increased 2.25-fold during the 8 years. The lower extremity was the most common site of venous thrombosis.

CONCLUSION

The incidence of VTE in a population younger than 30 years was 13.11 per 100,000 persons in Korea. We found a bimodal age distribution of the VTE incidence with peaks at infancy and again after 16 years. The incidence of portal vein thrombosis was high in infants, and infection and malignancy were the most common comorbidities in patients with VTE.

Cardiovascular recurrence of high-grade osteosarcoma presenting as atrial thrombosis and pulmonary embolism: A case report and review of the pediatric literature

In the era of neoadjuvant and adjuvant chemotherapy, extrapulmonary involvement by high-grade osteosarcoma (HGOS) is rare. Importantly however, HGOS metastasis in the form of cardiovascular tumor thrombus portends a dismal prognosis. Thus, prompt and accurate identification of tumor thrombus is crucial. We report here two unique cases of recurrent HGOS, presenting as thrombotic events, in order to increase awareness and index of suspicion among practitioners regarding this presentation. Additionally, we review 14 previously reported pediatric cases of cardiovascular metastatic HGOS.