Thromboembolism and venous thrombosis of the deep veins in surgical children--an increasing challenge?

Venous Thromboembolism in the Inflammatory Rheumatic Diseases

Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a cardiovascular event whose risk is increased in most inflammatory rheumatic diseases (IRDs). Mechanisms that increase VTE risk include antiphospholipid antibodies (APLs), particularly anticardiolipin antibodies, anti-beta2glycoprotein I antibodies and lupus anticoagulant present together, and inflammation-mediated endothelial injury. Patients with IRDs should receive long-term anticoagulation drugs when the risk of VTE recurrence is high. In the light of recent warnings from regulatory agencies regarding heightened VTE risk with Janus kinase inhibitors, these drugs should be initiated only after a careful assessment of VTE risk in those with IRDs.

Ultrasound diagnosis and follow-up of Takayasu arteritis with femoral vein involvement

Takayasu arteritis (TA) is a form of chronic vasculitis that mainly affects the aorta and its main branches, most commonly in young female patients. The pathogenesis of the disease remains unclear, and the clinical manifestations are nonspecific. Therefore, misdiagnosis of the disease is considered to be common. Moreover, to the best of our knowledge, TA affecting veins has not been reported. Here we report a case of an adolescent with TA affecting the femoral vein as diagnosed by ultrasound.

Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement

OBJECTIVES

With the apparent increase in venous thromboembolism noted in the pediatric population, it is important to define which children are at risk for clots and to determine optimal preventative therapy. The purpose of this study was to determine the risk factors for venous thromboembolism in pediatric patients with central venous line placement.

METHODS

This was an observational, retrospective, case-control study. Control subjects were patients aged 0 to 18 years who had a central venous line placed. Case subjects had a central line and a radiographically confirmed diagnosis of venous thromboembolism.

RESULTS

A total of 150 patients were included in the study. Presence of multiple comorbidities, particularly the presence of a congenital heart defect (34.7% case vs. 14.7% control; p < 0.005), was found to put pediatric patients at increased risk for thrombosis. Additionally, the administration of parenteral nutrition through the central line (34.7% case vs. 18.7% control; p = 0.03) and location of the line increased the risk for clot formation.

CONCLUSIONS

With increased awareness of central venous line-related thromboembolism, measures should be taken to reduce the number and duration of central line placements, and further studies addressing the need for thromboprophylaxis should be conducted.