1
|
Lapite A, Abu-Arja MH, Han H, Lee-Kim Y, Sartain SE, Cohen CT. Management of neonatal and infant aortic thrombosis: A single-center case series. Pediatr Blood Cancer 2024:e31283. [PMID: 39152633 DOI: 10.1002/pbc.31283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/19/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
Neonatal and infant aortic thrombosis is a rare albeit life-threatening thrombotic event, particularly seen in premature infants with an arterial catheter in place. We describe our institutional experience and approach to the management of 11 infants with occlusive or nearly occlusive aortic thrombosis. We observed at least partial thrombus resolution in all patients. Complications related to our management included minor bleeding in two children receiving thrombolytic therapy, and two major bleeding events in children receiving anticoagulation alone. Our experience adds to the growing body of evidence that thrombolysis and thrombectomy should be considered in managing neonatal/infant aortic thrombosis.
Collapse
Affiliation(s)
- Ajibike Lapite
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Mohammad H Abu-Arja
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Hyojeong Han
- Division of Pediatric Hematology/Oncology, Children's National Hospital, Washington, District of Columbia, USA
- Division of Blood Banking and Transfusion Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - YoungNa Lee-Kim
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Sarah E Sartain
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Clay T Cohen
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| |
Collapse
|
2
|
Abdelghani E, Agarwal S, Stanek J, Sankar A, Kerlin BA, Rodriguez V. Pediatric arterial thrombosis: A single-institution cohort study of patient characteristics and thrombosis outcomes. Pediatr Blood Cancer 2024; 71:e30756. [PMID: 37902500 DOI: 10.1002/pbc.30756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Arterial thrombosis (AT) is an increasingly recognized complication in pediatrics. Consensus clinical practice guidelines suggest immediate removal of the indwelling arterial catheter and a short course (5-7 days) of anticoagulation. The optimal duration and modality of antithrombotic therapy in children are yet to be determined. AIMS Describe treatment patterns and outcomes in pediatric patients with AT and explore predictors for complete thrombus resolution or long-term complications. METHODS Single-institution retrospective study. Patients were identified by ICD-9 and ICD-10 codes for the diagnosis of AT or reports of AT on ultrasound from January 1, 2012, to October 1, 2022. Descriptive and logistic regression analyses were used. RESULTS 101 patients were included. The median age was 2.2 months. The most common underlying diagnoses were congenital heart disease (39.6%) and infection (22.8%). A majority of patients had symptomatic thrombosis in an extremity, and 78% were catheter-associated. 81% of patients received anticoagulation with a median duration of 35 days. Out of the 70 patients who were treated with anticoagulation alone and had a follow-up imaging, 70% had complete resolution after 90 days of anticoagulation. No clear predictors of complete resolution were identified. Eighteen patients had long-term sequelae secondary to arterial insufficiency. Those with infection-associated AT were more likely to have long-term complications. The major and clinically relevant non-major bleeding rate was 11%. CONCLUSION Duration of anticoagulation was widely variable, and 70% of patients achieved complete resolution by 90 days of anticoagulation. A significant proportion of patients developed long-term sequelae secondary to arterial insufficiency. Sepsis/infection at the time of diagnosis with AT was more likely to be associated with long-term complications.
Collapse
Affiliation(s)
- Eman Abdelghani
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shreya Agarwal
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Biostatistics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amanda Sankar
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Bryce A Kerlin
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
3
|
Sánchez LM, Snarr BS, Soni H, Lee-Kim Y, Cohen CT. Arterial thrombosis in a newborn with homozygous plasminogen activator inhibitor-1 4G/4G polymorphism. Pediatr Blood Cancer 2022; 69:e29586. [PMID: 35147281 DOI: 10.1002/pbc.29586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Luisanna M Sánchez
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Brian S Snarr
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Heather Soni
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - YoungNa Lee-Kim
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
4
|
Paes B, Chan AKC, Shaik M, Patel D, Bhatt MD. Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study. Blood Coagul Fibrinolysis 2022; 33:83-89. [PMID: 35001043 DOI: 10.1097/mbc.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of neonatal venous and arterial thrombosis ranges from 6.9 to 15/1000 neonatal ICU (NICU) admissions, and is likely an underestimate based on population demographics, frequency of surveillance and vascular catheterization. This retrospective study involving 234 infants reviewed the epidemiology, diagnosis, and management of neonatal thrombosis in a single, tertiary care institution over more than 10 years. The incidence of thrombosis was 25/1000 NICU admissions, with a preterm to term infant ratio of 1.5 : 1 and a slightly higher proportion of male sex (55.1%). The mean (range) gestational age and birth weight was 33.8 weeks (23-41.6) and 2360 g (512-5890). The median age (IQR) of thrombus diagnosis was 7 (3-17) days. Portal vein thrombosis was most prevalent (59.4%) compared with other sites of thrombosis. Almost three-quarter (171/234; 73.1%) of the thrombotic episodes were line-related, while infection and surgery were associated with 19.7% (46/234) and 10.7% (25/234), respectively. Twenty patients (8.3%) were screened for thrombophilia and 3 were positive; 2 for antithrombin deficiency, 1 for factor V Leiden gene mutation. Subjects were followed with imaging for 3 months with a treatment duration, mean (IQR) of 33.5 (10.8-42.5) days. Complete clot resolution was significantly higher in the anticoagulation group (48%; 17%; P = 0.03) compared with untreated patients. No group difference was noted for partial thrombus resolution (33.3%; 12.4%; P = 0.313). Anticoagulation halted thrombus progression (2.6 versus 12.4%; P = 0.025) and fewer treated patients failed to attend follow-up visits (6.5 versus 18.6%; P = 0.022). Well designed, multicenter prospective studies with larger sample sizes are required to confirm these findings.
Collapse
Affiliation(s)
- Bosco Paes
- Division of Neonatology, Department of Pediatrics
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
| | | | - Dhiman Patel
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
| |
Collapse
|
5
|
Crameri O, Brotschi B, Achini F, Rizzi M, Albisetti M. Treatment of Catheter-Related Arterial Thrombosis in Children: A 15-Year Single- Center Experience. J Pediatr 2021; 239:182-186. [PMID: 34450125 DOI: 10.1016/j.jpeds.2021.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/14/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate treatment modalities for children with extremity indwelling catheter (EIC)- or cardiac catheter-related arterial thrombosis. STUDY DESIGN The treatment of consecutive cases of catheter-related arterial thrombosis (CAT) at our institution between 2002 and 2017 was analyzed retrospectively. RESULTS A total of 242 CATs developed in 224 children. Of these, 125 (52%) were EIC-related and 117 (48%) were cardiac catheter-related. Treatment included heparin alone in 60 cases (25%), acetylsalicyclic acid (ASA) alone in 6 cases (2%), heparin followed by ASA in 171 cases (71%), heparin followed by vitamin K antagonist (VKA) in 4 cases (1.5%), and VKA alone in 1 case (0.5%). Complete resolution of CAT was observed in 173 cases (71.5%), partial resolution in 13 cases (5.4%), and no resolution in 56 cases (23.1%). No statistical significance in the resolution rate was observed between treatment groups (P = .23). In 66% of cases, complete resolution occurred at a median of 18 days (range, 4-44 days) with heparin alone. A switch from heparin to ASA in children with partial or no resolution of CAT did not increase the resolution rate at follow-up. CONCLUSIONS Heparin is an efficient treatment modality for CAT in pediatric patients. Long-term, subsequent treatment with ASA does not increase the resolution rate.
Collapse
Affiliation(s)
- Ornella Crameri
- Division of Hematology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- Intensive Care and Neonatology Unit, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Federica Achini
- Division of Hematology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mattia Rizzi
- Hematology/Oncology Unit, Division of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuela Albisetti
- Division of Hematology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|