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For: Amankwah EK, Atchison CM, Arlikar S, Ayala I, Barrett L, Branchford BR, Streiff M, Takemoto C, Goldenberg NA. Risk factors for hospital-sssociated venous thromboembolism in the neonatal intensive care unit. Thromb Res 2014;134:305-9. [PMID: 24953982 DOI: 10.1016/j.thromres.2014.05.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/21/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]

For:	Amankwah EK, Atchison CM, Arlikar S, Ayala I, Barrett L, Branchford BR, Streiff M, Takemoto C, Goldenberg NA. Risk factors for hospital-sssociated venous thromboembolism in the neonatal intensive care unit. Thromb Res 2014;134:305-9. [PMID: 24953982 DOI: 10.1016/j.thromres.2014.05.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/21/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]

Number

Cited by Other Article(s)

van Ommen CH, Luijnenburg SE. Anticoagulation of pediatric patients with venous thromboembolism in 2023. Thromb Res 2024;235:186-193. [PMID: 38378308 DOI: 10.1016/j.thromres.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/24/2023] [Accepted: 12/24/2023] [Indexed: 02/22/2024]

Havlicek EE, Goldman ZA, Faustino EVS, Ignjatovic V, Goldenberg NA, Sochet AA. Hospital-acquired venous thromboembolism during invasive mechanical ventilation in children: a single-center, retrospective cohort study. J Thromb Haemost 2023;21:3145-3152. [PMID: 37423387 DOI: 10.1016/j.jtha.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]

Abstract

BACKGROUND

Invasive mechanical ventilation (IMV) has been independently associated with hospital-acquired venous thromboembolism (HA-VTE) among critically ill children, including extremity deep venous thrombosis and pulmonary embolism.

OBJECTIVES

We aimed to characterize the frequency and timing of HA-VTE following IMV exposure.

METHODS

This was a single-center, retrospective cohort study including children aged <18 years, hospitalized in a pediatric intensive care unit, undergoing mechanical ventilation for >24 hours from October 2020 through April 2022. Encounters with an existing tracheostomy or receiving treatment for HA-VTE prior to endotracheal intubation were excluded. The primary outcomes characterized clinically-relevant HA-VTE, including timing after intubation, location, and the presence of known hypercoagulability risk factors. Secondary outcomes were IMV exposure magnitude, defined by IMV duration and ventilator parameters (ie, volumetric, barometric, and oxygenation indices).

RESULTS

Of 170 consecutive, eligible encounters, 18 (10.6%) experienced HA-VTE at a median of 4 days (IQR, 1.4-6.4) following endotracheal intubation. Those with HA-VTE had an increased frequency of a prior venous thromboembolism (27.8% vs 8.6%, P = .027). No differences in frequency of other HA-VTE risk factors (ie, acute immobility, hematologic malignancy, sepsis, and COVID-19-related illness), presence of a concurrent central venous catheter, or the magnitude of IMV exposure were noted.

CONCLUSION

Children undergoing IMV experience HA-VTE at markedly higher rates than previously estimated in the general pediatric intensive care unit population after endotracheal intubation. While prospective validation is needed, these findings are an important step toward informing the development of risk-stratified thromboprophylaxis trials in critically ill children.

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Khizroeva J, Makatsariya A, Vorobev A, Bitsadze V, Elalamy I, Lazarchuk A, Salnikova P, Einullaeva S, Solopova A, Tretykova M, Antonova A, Mashkova T, Grigoreva K, Kvaratskheliia M, Yakubova F, Degtyareva N, Tsibizova V, Gashimova N, Blbulyan D. The Hemostatic System in Newborns and the Risk of Neonatal Thrombosis. Int J Mol Sci 2023;24:13864. [PMID: 37762167 PMCID: PMC10530883 DOI: 10.3390/ijms241813864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open

Affiliation(s)

Jamilya Khizroeva Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Alexander Makatsariya Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Alexander Vorobev Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Victoria Bitsadze Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Ismail Elalamy Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.) Hematology and Thrombosis Center, Tenon Hospital, Sorbonne University, 4 Rue de la Chine, 75020 Paris, France
Arina Lazarchuk Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Polina Salnikova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Sabina Einullaeva Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Antonina Solopova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Maria Tretykova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Alexandra Antonova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Tamara Mashkova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Kristina Grigoreva Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Margaret Kvaratskheliia Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Fidan Yakubova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Natalia Degtyareva Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
Valentina Tsibizova Almazov National Medical Research Centre, Health Ministry of Russian Federation, 2 Akkuratova Str., 197341 Saint Petersburg, Russia;
Nilufar Gashimova Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
David Blbulyan Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)

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Song S, Li Z, Zhao G, Li X, Wang R, Li B, Liu Q. Epidemiology and risk factors for thrombosis in children and newborns: systematic evaluation and meta-analysis. BMC Pediatr 2023;23:292. [PMID: 37322473 PMCID: PMC10267552 DOI: 10.1186/s12887-023-04122-x] [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: 01/13/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open

Abstract

BACKGROUND

Thrombosis is a serious condition in children and neonates. However, the risk factors for thrombosis have not been conclusively determined. This study aimed to identify the risk factors for thrombosis in children and neonates in Intensive Care Unit (ICU) through a meta-analysis to better guide clinical treatment.

METHODS

A systematic search of electronic databases (PubMed, Embase, Cochrane Library, WOS, CNKI, Wanfang, VIP) was conducted to retrieve studies from creation on 23 May 2022. Data on the year of publication, study design, country of origin, number of patients/controls, ethnicity, and type of thrombus were extracted. The publication bias and heterogeneity between studies were assessed, and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using fixed or random effects models.

RESULTS

A total of 18 studies met the inclusion criteria. The incidence of thrombosis in children was 2% per year (95% CI 1%-2%, P < 0.01). Infection and sepsis (OR = 1.95, P < 0.01), CVC (OR = 3.66, [95%CL 1.78-7.51], P < 0.01), mechanical ventilation (OR = 2.1, [95%CL1.47-3.01], P < 0.01), surgery (OR = 2.25, [95%CL1.2-4.22], P < 0.01), respiratory distress (OR = 1.39, [95%CL0.42-4.63], P < 0.01), ethnicities (OR = 0.88, [95%CL 0.79-0.98], P = 0.78), gestational age (OR = 1.5, [95%CL1.34-1.68], P = 0.65)were identified as risk factors for thrombosis.

CONCLUSIONS

This meta-analysis suggests that CVC, Surgery, mechanical ventilation, Infection/sepsis, gestational age, Respiratory distress, and different ethnicities are risk factors for thrombosis in children and neonates in ICU. These findings may help clinicians to identify high-risk patients and develop appropriate prevention strategies.

TRIAL REGISTRATION

PROSPERO (CRD 42022333449).

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Donner JR, Ganta A, Polikoff L, Snelling L, Serrano-Gonzalez M. A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium. AACE Clin Case Rep 2023;9:85-88. [PMID: 37251976 PMCID: PMC10213609 DOI: 10.1016/j.aace.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open

Whitworth H, Beslow LA, Hubbard RA, Leonard CE, Scobell R, Witmer C, Raffini L. Outcomes in infants with unprovoked venous thromboembolism: A retrospective cohort study. Res Pract Thromb Haemost 2023;7:100174. [PMID: 37538506 PMCID: PMC10394551 DOI: 10.1016/j.rpth.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/16/2023] [Accepted: 05/03/2023] [Indexed: 08/05/2023] Open

Abdulaziz-Opiela G, Sobieraj A, Sibrecht G, Bajdor J, Mroziński B, Kozłowska Z, Iciek R, Wróblewska-Seniuk K, Wender-Ożegowska E, Szczapa T. Prenatal and Neonatal Pulmonary Thrombosis as a Potential Complication of SARS-CoV-2 Infection in Late Pregnancy. Int J Mol Sci 2023;24:ijms24087629. [PMID: 37108791 PMCID: PMC10146603 DOI: 10.3390/ijms24087629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open

Sochet AA, Havlicek EE, Faustino EVS, Goldenberg NA. Mechanical Ventilation and Hospital-Acquired Venous Thromboembolism Among Critically Ill Children. Hosp Pediatr 2022;12:1099-1109. [PMID: 36349533 DOI: 10.1542/hpeds.2022-006697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]

Risk factors for hospital acquired venous thromboembolism in congenital heart disease patients: A report from the children's hospital acquired thrombosis (CHAT) consortium. Thromb Res 2022;220:116-120. [DOI: 10.1016/j.thromres.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]

Stephens ET, Nguyen ATH, Jaffray J, Branchford B, Amankwah EK, Goldenberg NA, Faustino EVS, Zakai NA, Stillings A, Krava E, Young G, Fargo JH. Risk of venous thromboembolism in pediatric hospitalized patients undergoing noncardiac surgery: A report from the Children's Hospital-Acquired Thrombosis consortium. Res Pract Thromb Haemost 2022;6:e12810. [PMID: 36254253 PMCID: PMC9561357 DOI: 10.1002/rth2.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open

Sochet AA, Morrison JM, Jaffray J, Godiwala N, Wilson HP, Thornburg CD, Bhat RV, Zia A, Lawrence C, Kudchadkar SR, Hamblin F, Russell CJ, Streiff MB, Spyropoulos AC, Amankwah EK, Goldenberg NA. Enoxaparin Thromboprophylaxis in Children Hospitalized for COVID-19: A Phase 2 Trial. Pediatrics 2022;150:e2022056726. [PMID: 35484817 DOI: 10.1542/peds.2022-056726] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open

Abstract

BACKGROUND

Evidence regarding the safety and efficacy of anticoagulant thromboprophylaxis among pediatric patients hospitalized for coronavirus disease 2019 (COVID-19) is limited. We sought to evaluate safety, dose-finding, and preliminary efficacy of twice-daily enoxaparin as primary thromboprophylaxis among children hospitalized for symptomatic COVID-19, including primary respiratory infection and multisystem inflammatory syndrome in children (MISC).

METHODS

We performed a phase 2, multicenter, prospective, open-label, single-arm clinical trial of twice-daily enoxaparin (initial dose: 0.5mg/kg per dose; max: 60mg; target anti-Xa activity: 0.20-0.49IU/mL) as primary thromboprophylaxis for children <18 years of age hospitalized for symptomatic COVID-19. Study endpoints included: cumulative incidence of International Society of Thrombosis and Haemostasis-defined clinically relevant bleeding; enoxaparin dose-requirements; and cumulative incidence of venous thromboembolism within 30-days of hospital discharge. Descriptive statistics summarized endpoint estimates that were further evaluated by participant age (±12 years) and clinical presentation.

RESULTS

Forty children were enrolled and 38 met analyses criteria. None experienced clinically relevant bleeding. Median (interquartile range) dose to achieve target anti-Xa levels was 0.5 mg/kg (0.48-0.54). Dose-requirement did not differ by age (0.5 [0.46-0.52] mg/kg for age ≥12 years versus 0.52 [0.49-0.55] mg/kg for age <12 years, P = .51) but was greater for participants with MISC (0.52 [0.5-0.61] mg/kg) as compared with primary COVID-19 (0.48 [0.39-0.51] mg/kg, P = .010). Two children (5.3%) developed central-venous catheter-related venous thromboembolism. No serious adverse events were related to trial intervention.

CONCLUSIONS

Among children hospitalized for COVID-19, thromboprophylaxis with twice-daily enoxaparin appears safe and warrants further investigation to assess efficacy.

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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]

Bhat R, Kwon S, Zaniletti I, Murthy K, Liem RI. Risk factors associated with venous and arterial neonatal thrombosis in the intensive care unit: a multicentre case-control study. THE LANCET HAEMATOLOGY 2022;9:e200-e207. [DOI: 10.1016/s2352-3026(21)00399-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]

Predictors of venous thromboembolism among infants in children's hospitals in the United States: a retrospective Pediatric Health Information Study. J Perinatol 2022;42:103-109. [PMID: 34657144 PMCID: PMC8520347 DOI: 10.1038/s41372-021-01232-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/02/2021] [Accepted: 10/01/2021] [Indexed: 01/28/2023]

Jaffray J, Mahajerin A, Branchford B, Nguyen ATH, Faustino EVS, Silvey M, Croteau SE, Fargo JH, Cooper JD, Bakeer N, Zakai NA, Stillings A, Krava E, Amankwah EK, Young G, Goldenberg NA. A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children: A Report From the Children's Hospital-Acquired Thrombosis Consortium. Pediatr Crit Care Med 2022;23:e1-e9. [PMID: 34406168 PMCID: PMC8738123 DOI: 10.1097/pcc.0000000000002826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]

Abstract

OBJECTIVES

To create a risk model for hospital-acquired venous thromboembolism in critically ill children upon admission to an ICU.

DESIGN

Case-control study.

SETTING

ICUs from eight children's hospitals throughout the United States.

SUBJECTS

Critically ill children with hospital-acquired venous thromboembolism (cases) 0-21 years old and similar children without hospital-acquired venous thromboembolism (controls) from January 2012 to December 2016. Children with a recent cardiac surgery, asymptomatic venous thromboembolism, or a venous thromboembolism diagnosed before ICU admission were excluded.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The multi-institutional Children's Hospital-Acquired Thrombosis registry was used to identify cases and controls. Multivariable logistic regression was used to determine the association between hospital-acquired venous thromboembolism and putative risk factors present at or within 24 hours of ICU admission to develop the final model. A total of 548 hospital-acquired venous thromboembolism cases (median age, 0.8 yr; interquartile range, 0.1-10.2) and 187 controls (median age, 2.4 yr; interquartile range, 0.2-8.3) were analyzed. In the multivariable model, recent central venous catheter placement (odds ratio, 4.4; 95% CI, 2.7-7.1), immobility (odds ratio 3.6, 95% CI, 2.1-6.2), congenital heart disease (odds ratio 2.9, 95% CI, 1.7-4.7), length of hospital stay prior to ICU admission greater than or equal to 3 days (odds ratio, 2.5; 95% CI, 1.1-5.6), and history of autoimmune/inflammatory condition or current infection (odds ratio, 2.1; 95% CI, 1.2-3.4) were each independently associated with hospital-acquired venous thromboembolism. The risk model had an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.73-0.84).

CONCLUSIONS

Using the multicenter Children's Hospital-Acquired Thrombosis registry, we identified five independent risk factors for hospital-acquired venous thromboembolism in critically ill children, deriving a new hospital-acquired venous thromboembolism risk assessment model. A prospective validation study is underway to define a high-risk group for risk-stratified interventional trials investigating the efficacy and safety of prophylactic anticoagulation in critically ill children.

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Affiliation(s)

Julie Jaffray Children’s Hospital Los Angeles, Los Angeles, CA, USA University of Southern California Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
Arash Mahajerin CHOC Children’s Hospital, Orange, CA, USA
Brian Branchford Children’s Hospital Colorado, Aurora, CO, USA University of Colorado School of Medicine, Aurora, CO, USA Versiti Blood Research Institute, Milwaukee, WI, USA
Anh Thy H. Nguyen Data Coordinating Center, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL, USA
E. Vincent S. Faustino Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
Michael Silvey Children’s Mercy Hospital, Kansas City, MO, USA
Stacy E. Croteau Boston Children’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
John H. Fargo Akron Children’s Hospital, Akron, OH, USA
James D. Cooper Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
Nihal Bakeer Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
Neil A. Zakai Larner College of Medicine at the University of Vermont, Department of Medicine and Department of Pathology & Laboratory Medicine, Burlington, VT, USA
Amy Stillings Children’s Hospital Los Angeles, Los Angeles, CA, USA
Emily Krava Children’s Hospital Los Angeles, Los Angeles, CA, USA
Ernest K. Amankwah Data Coordinating Center, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL, USA Johns Hopkins University School of Medicine, Departments of Oncology and Pediatrics, Baltimore, MD, USA
Guy Young Children’s Hospital Los Angeles, Los Angeles, CA, USA University of Southern California Keck School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
Neil A. Goldenberg Data Coordinating Center, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL, USA Johns Hopkins University School of Medicine, Departments of Pediatrics and Medicine, Baltimore, MD, USA

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Fort P, Beg K, Betensky M, Kiskaddon A, Goldenberg NA. Venous Thromboembolism in Premature Neonates. Semin Thromb Hemost 2021;48:422-433. [PMID: 34942667 DOI: 10.1055/s-0041-1740267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]

Affiliation(s)

Prem Fort Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Maternal Fetal and Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
Kisha Beg Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow Transplantation, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
Marisol Betensky Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
Amy Kiskaddon Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Neil A Goldenberg Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Pediatrics, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Vorobev AV, Bitsadze VO, Khizroeva JK, Potapkina SA, Makatsariya NA, Rizzo G, Di Renzo GC, Blinov DV, Pankratyeva LL, Tsibizova VI. Neonatal thrombosis: risk factors and principles of prophylaxis. OBSTETRICS, GYNECOLOGY AND REPRODUCTION 2021. [DOI: 10.17749/2313-7347/ob.gyn.rep.2021.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]

Sochet AA, Kiskaddon A, Betensky M, Goldenberg N. Venous Thromboembolism among Critically Ill Children: A Narrative Review. Semin Thromb Hemost 2021;47:631-642. [PMID: 34058768 DOI: 10.1055/s-0041-1722847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]

Morrison JM, Betensky M, Kiskaddon AL, Goldenberg NA. Venous Thromboembolism among Noncritically Ill Hospitalized Children: Key Considerations for the Pediatric Hospital Medicine Specialist. Semin Thromb Hemost 2021;48:434-445. [PMID: 33962474 DOI: 10.1055/s-0041-1729170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

Kurimoto T, Shimoji Y, Shimabukuro A, Ohshiro T. Recombinant tissue-type plasminogen activator treatment in an extremely low birth weight infant. Clin Case Rep 2021;9:e04236. [PMID: 34026194 PMCID: PMC8123542 DOI: 10.1002/ccr3.4236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/07/2022] Open

Adult Donor Blood Products as Risk Factors for Central Venous Catheter-associated Thromboembolism in Neonates: A Retrospective Case-Control Study. J Pediatr Hematol Oncol 2021;43:e255-e259. [PMID: 32459720 DOI: 10.1097/mph.0000000000001821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/01/2020] [Indexed: 11/26/2022]

Bhatt MD, Chan AKC. Venous thrombosis in neonates. Fac Rev 2021;10:20. [PMID: 33718937 PMCID: PMC7946391 DOI: 10.12703/r/10-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open

Jaffray J, Branchford B, Goldenberg N, Malvar J, Croteau SE, Silvey M, Fargo JH, Cooper JD, Bakeer N, Sposto R, Ji L, Zakai NA, Faustino EVS, Stillings A, Krava E, Young G, Mahajerin A. Development of a Risk Model for Pediatric Hospital-Acquired Thrombosis: A Report from the Children's Hospital-Acquired Thrombosis Consortium. J Pediatr 2021;228:252-259.e1. [PMID: 32920105 PMCID: PMC7752847 DOI: 10.1016/j.jpeds.2020.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]

Ostroff M, Zauk A, Chowdhury S, Moureau N, Mobley C. A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit. J Vasc Access 2020;22:926-934. [PMID: 33148114 DOI: 10.1177/1129729820969291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open

Abstract

OBJECTIVE

The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU).

METHODS

Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018-2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU.

RESULTS

Placement of ST-FICCs were successful in 100% of neonates (n = 82/82) with 94% to the right (n = 77/82) and 6% to the left common femoral veins (n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr (n = 80/82), 2.6Fr (n = 1/82), and 3-Fr (n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) (n = 33/82), IVC/right atrial junction (n = 31/82), or right atrium (n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins (n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter.

CONCLUSION

Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

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Bitsadze V, Nalli C, Khizroeva J, Lini D, Andreoli L, Lojacono A, Fazzi E, Shoenfeld Y, Tincani A, Makatsariya A. "APS pregnancy - The offspring". Lupus 2020;29:1336-1345. [PMID: 32752918 DOI: 10.1177/0961203320947154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]

Affiliation(s)

Viktoria Bitsadze Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Cecilia Nalli Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy
Jamilya Khizroeva Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Daniele Lini Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
Laura Andreoli Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
Andrea Lojacono Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Obstetric and Gynecology Unit, ASST Spedali Civili, Brescia, Italy
Elisa Fazzi Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Child Neurology and Psychiatry Unit, ASST Spedali Civili, Brescia, Italy
Yehuda Shoenfeld I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.,Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
Angela Tincani Rheumatology and Immunology Unit, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Alexander Makatsariya Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

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Hospital-Associated Venous Thromboembolism in a Pediatric Cardiac ICU: A Multivariable Predictive Algorithm to Identify Children at High Risk. Pediatr Crit Care Med 2020;21:e362-e368. [PMID: 32343105 DOI: 10.1097/pcc.0000000000002293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Abstract

OBJECTIVES

Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population.

DESIGN

This is a prospective observational single-center study.

SETTING

Tertiary care referral children's hospital cardiac ICU.

PATIENTS

Children less than or equal to18 years old admitted to the cardiac ICU who developed a hospital-associated venous thromboembolism from December 2013 to June 2017 were included. Odds ratios and 95% CIs are reported for multivariable predictors.

MEASUREMENTS AND MAIN RESULTS

A total of 2,204 separate cardiac ICU encounters were evaluated with 56 hospital-associated venous thromboembolisms identified in 52 unique patients, yielding an overall prevalence of 25 hospital-associated venous thromboembolism per 1,000 cardiac ICU encounters. We were able to create a predictive algorithm with good internal validity that performs well at predicting hospital-associated venous thromboembolism. The presence of a central venous catheter (odds ratio, 4.76; 95% CI, 2.0-11.1), sepsis (odds ratio, 3.5; 95% CI, 1.5-8.0), single ventricle disease (odds ratio, 2.2; 95% CI, 1.2-3.9), and extracorporeal membrane oxygenation support (odds ratio, 2.7; 95% CI, 1.2-5.7) were independent risk factors for hospital-associated venous thromboembolism. Encounters with hospital-associated venous thromboembolism were associated with a higher rate of stroke (17% vs 1.2%; p < 0.001).

CONCLUSIONS

We developed a multivariable predictive algorithm to help identify children who may be at high risk of hospital-associated venous thromboembolism in the pediatric cardiac ICU.

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Makatsariya A, Bitsadze V, Khizroeva J, Vorobev A, Makatsariya N, Egorova E, Mischenko A, Mashkova T, Antonova A. Neonatal thrombosis. J Matern Fetal Neonatal Med 2020;35:1169-1177. [PMID: 32204642 DOI: 10.1080/14767058.2020.1743668] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]

Abstract

Neonatal thromboembolism in pediatric patients is a rare but life-threatening condition mainly caused by combinations of at least 2 prothrombotic triggering risk factors such as the central venous lines, septic condition, and prematurity. Other risk factors include asphyxia, dehydration, liver dysfunction, inflammation, and maternal condition. Neonatal hemostatic system is different from one of the older children and adults. Coagulation proteins do not cross the placenta but are synthesized in the fetus from an early stage. In the term neonate, concentrations of several procoagulant proteins, particularly the vitamin K dependent and contact factors are reduced when compared with adults. Conversely, levels of antithrombin, heparin cofactor II and protein C and S are low at birth and fibrinolysis system is characterized by the decreased level of plasminogen and alpha-1-antiplasmin, increased tissue plasminogen activator. These features all tend to be gestational dependent and are more present in the preterm infant. Primarily in this context neonates appear to be at a higher risk of thrombosis than older children. Thrombotic complications reach their peak in the group of children born at 22-27 weeks. The role of inherited thrombophilic risk factors in neonatal VTE development is poorly defined. The presence of inherited and acquired thrombophilia in mother and newborn is also responsible for the development of thrombosis in neonates and should be considered. Thrombophilia in the mother can lead to increased coagulation potential and prethrombotic conditions during pregnancy, causing thrombotic vasculopathy at the placental level. The benefit of identifying thrombophilia in the sick preterm newborns who are in the group of risk for development of thrombotic complications may facilitate the thromboprophylaxis. Further research regarding assessment of risk factors, diagnostics and treatment strategy is required.

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Bhat R, Monagle P. Anticoagulation in preterm and term neonates: Why are they special? Thromb Res 2020;187:113-121. [DOI: 10.1016/j.thromres.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 01/19/2023]

Park ES, Choi HS, Lee KS, Kim SW, Lee JM. Venous Thromboembolism in Children and Young Adults in Korea: Analysis of the Korean Health Insurance Review and Assessment Service Database. J Korean Med Sci 2019;34:e316. [PMID: 31858756 PMCID: PMC6926097 DOI: 10.3346/jkms.2019.34.e316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022] Open

Rothstein DH, Cairo SB, Schaefer BA, Lautz TB. Association of perioperative red blood cell transfusion with postoperative venous thromboembolism in pediatric patients: A propensity score matched analysis. Pediatr Blood Cancer 2019;66:e27919. [PMID: 31298495 DOI: 10.1002/pbc.27919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023]

Östlund Å, Fläring U, Norberg Å, Dahlberg A, Berner J, Kaiser S, Vermin L, Svenningsson A, Frisk T, Larsson P, Andersson A. Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters. Br J Anaesth 2019;123:316-324. [DOI: 10.1016/j.bja.2019.04.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open

Derderian SC, Good R, Vuille-Dit-Bille RN, Carpenter T, Bensard DD. Central venous lines in critically ill children: Thrombosis but not infection is site dependent. J Pediatr Surg 2019;54:1740-1743. [PMID: 30661643 DOI: 10.1016/j.jpedsurg.2018.10.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/18/2018] [Accepted: 10/31/2018] [Indexed: 11/16/2022]

Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis. Intensive Crit Care Nurs 2019;56:102753. [PMID: 31445794 DOI: 10.1016/j.iccn.2019.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]

Zhang C, Zhang Z, Mi J, Wang X, Zou Y, Chen X, Nie Z, Luo X, Gan R. The cumulative venous thromboembolism incidence and risk factors in intensive care patients receiving the guideline-recommended thromboprophylaxis. Medicine (Baltimore) 2019;98:e15833. [PMID: 31169685 PMCID: PMC6571428 DOI: 10.1097/md.0000000000015833] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open

Abstract

Few prospective studies have reported the cumulative incidence of venous thromboembolism (VTE) in the intensive care unit (ICU), especially for patients receiving guideline-recommended VTE prophylaxis. We aimed to design a prospective observational study to investigate the cumulative incidence and risk factors of ICU-acquired VTE for those populations.We prospectively studied 281 consecutively included patients in the ICU at a single center. All patients provided informed consent. Patients received ultrasound evaluation and were followed for VTE before ICU discharge or within 28 days of ICU stay. The type of VTE thromboprophylaxis was also recorded for all patients. Variables from univariate analyses that were associated with VTE were included in the binary logistic regression analysis to determine VTE predictors. The cumulative VTE incidence with 95% confidence interval (CI) was estimated using Kaplan-Meier methods.Patients had a median age of 60 years (range, 18-89) and an acute physiology and chronic health evaluation II score of 17 (range, 4-36). Despite all patients receiving guideline-recommended thromboprophylaxis, the cumulative incidence of VTE at 7, 14, 21, and 28 days was 4.45% (95% CI 2.55-7.71), 7.14% (95% CI 4.61-10.97), 7.53% (95% CI 4.92-11.43), and 9.55% (95% CI 6.55-13.81), respectively. Central venous catheter use (P = .002, odds ratio [OR] = 4.50), Caprini score (P = .012, OR = 1.20), and ICU length of stay (P = .006, OR = 1.08) were independent risk factors related to the incidence of VTE for patients admitted to the ICU.Our prospective observational study found that the 28-day cumulative incidence of VTE was relatively high for patients admitted to the ICU, despite the use of guideline-recommended thromboprophylaxis. Patients with femoral central venous catheter, prolonged ICU length of stay, or a high Caprini score may have an increased risk of developing VTE.

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Mousa A, Zakaria OM, Hanbal I, Nasr MA, Sultan TA, El-Hamid MA, El-Gibaly AM, Al-Arfaj H, Daha AS, Buhalim MA, Zakaria MY, Metwally DEE, Bosat BE, Sharabi A, Nienaa M, Amin MM, Rashed KA. Management of Extremity Venous Thrombosis in Neonates and Infants: An Experience From a Resource Challenged Setting. Clin Appl Thromb Hemost 2018;25:1076029618814353. [PMID: 30522332 PMCID: PMC6714954 DOI: 10.1177/1076029618814353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open

Affiliation(s)

Ahmed Mousa 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt.,2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Ossama M Zakaria 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.,3 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Ibrahim Hanbal 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Mohammed A Nasr 4 Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
Tamer A Sultan 5 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Mohamed Abd El-Hamid 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Amr M El-Gibaly 6 Department of General, Visceral, Thoracic and Vascular Surgery, Hanse Klinikum Stralsund, University Medicine of Greifswald, Stralsund, Germany
Haytham Al-Arfaj 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Ahmed S Daha 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Mohammed A Buhalim 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Mohamed Y Zakaria 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Dina E El Metwally 7 Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Bosat E Bosat 8 Department of General Surgery, Al-Zahraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
Alaa Sharabi 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Mohamed Nienaa 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Mahsoub M Amin 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
Khaled A Rashed 9 Department of Pediatrics, Al-Hussain University Hospital, Faculty of Medicine for Male, Al-Azhar University, Cairo, Egypt

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Experience and Prognosis of Systemic Neonatal Thrombosis at a Level III NICU. J Pediatr Hematol Oncol 2018;40:e410-e414. [PMID: 29750744 DOI: 10.1097/mph.0000000000001218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

Cairo SB, Lautz TB, Schaefer BA, Yu G, Naseem HUR, Rothstein DH. Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis. J Pediatr Surg 2018;53:1996-2002. [PMID: 29370891 DOI: 10.1016/j.jpedsurg.2017.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/24/2017] [Accepted: 12/14/2017] [Indexed: 12/19/2022]

Bhat R, Kumar R, Kwon S, Murthy K, Liem RI. Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit-A Case Control Study. J Pediatr 2018;195:28-32. [PMID: 29398052 DOI: 10.1016/j.jpeds.2017.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 02/03/2023]

Peng J, Rochow N, Dabaghi M, Bozanovic R, Jansen J, Predescu D, DeFrance B, Lee SY, Fusch G, Ravi Selvaganapathy P, Fusch C. Postnatal dilatation of umbilical cord vessels and its impact on wall integrity: Prerequisite for the artificial placenta. Int J Artif Organs 2018;41:393-399. [PMID: 29562805 DOI: 10.1177/0391398818763663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Femoral Vein Catheter is an Important Risk Factor for Catheter-related Thrombosis in (Near-)term Neonates. J Pediatr Hematol Oncol 2018;40:e64-e68. [PMID: 29016413 DOI: 10.1097/mph.0000000000000978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Pediatric issues in thrombosis and hemostasis: The how and why of venous thromboembolism risk stratification in hospitalized children. Thromb Res 2018;172:190-193. [PMID: 29472108 DOI: 10.1016/j.thromres.2018.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 01/23/2023]

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. Cardiol Young 2018;28:234-242. [PMID: 29115202 DOI: 10.1017/s1047951117001755] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]

Abstract

BACKGROUND

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals.

OBJECTIVE

The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

METHODS

We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.

RESULTS

Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.

CONCLUSION

Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

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Newall F, Branchford B, Male C. Anticoagulant prophylaxis and therapy in children: current challenges and emerging issues. J Thromb Haemost 2018;16:196-208. [PMID: 29316202 DOI: 10.1111/jth.13913] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]

Abstract

This review is aimed at describing the unique challenges of anticoagulant prophylaxis and treatment in children, and highlighting areas for research for improving clinical outcomes of children with thromboembolic disease. The evidence presented demonstrates the challenges of advancing the evidence base informing optimal management of thromboembolic disease in children. Recent observational studies have identified risk factors for venous thromboembolism in children, but there are few interventional studies assessing the benefit-risk balance of using thromboprophylaxis in risk-stratified clinical subgroups. A risk level-based framework is proposed for administering mechanical and pharmacological thromboprophylaxis. More research is required to refine the assignment of risk levels. The anticoagulants currently used predominantly in children are unfractionated heparin, low molecular weight heparin, and vitamin K antagonists. There is a paucity of robust evidence on the age-specific pharmacology of these agents, and their efficacy and safety for prevention and treatment of thrombosis in children. The available literature is heterogeneous, reflecting age-specific differences, and the various clinical settings for anticoagulation in children. Monitoring assays and target ranges are not well established. Nevertheless, weight-based dosing appears to achieve acceptable outcomes in most indications. Given the limitations of the classical anticoagulants for children, there is great interest in the direct oral anticoagulants (DOACs), whose properties appear to be particularly suitable for children. All DOACs currently approved for adults have Pediatric Investigation Plans ongoing or planned. These are generating age-specific formulations and systematic dosing information. The ongoing pediatric studies still have to establish whether DOACs have a positive benefit-risk balance in the various pediatric indications and age groups.

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Jaffray J, Mahajerin A, Young G, Goldenberg N, Ji L, Sposto R, Stillings A, Krava E, Branchford B. A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children's Hospital-Acquired Thrombosis (CHAT) project. Thromb Res 2018;161:67-72. [DOI: 10.1016/j.thromres.2017.11.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/06/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]

Branchford BR, Mahajerin A, Raffini L, Chalmers E, van Ommen CH, Chan AKC, Goldenberg NA. Recommendations for standardized risk factor definitions in pediatric hospital-acquired venous thromboembolism to inform future prevention trials: communication from the SSC of the ISTH. J Thromb Haemost 2017;15:2274-2278. [PMID: 29027741 DOI: 10.1111/jth.13848] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Indexed: 08/31/2023]

Knight-Perry J, Branchford BR, Thornhill D, Martiniano SL, Sagel SD, Wang M. Venous thromboembolism in children with cystic fibrosis: Retrospective incidence and intrapopulation risk factors. Thromb Res 2017;158:161-166. [PMID: 28934665 DOI: 10.1016/j.thromres.2017.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/02/2017] [Accepted: 08/31/2017] [Indexed: 01/17/2023]

Bohnhoff JC, DiSilvio SA, Aneja RK, Shenk JR, Domnina YA, Brozanski BS, Good M. Treatment and follow-up of venous thrombosis in the neonatal intensive care unit: a retrospective study. J Perinatol 2017;37:306-310. [PMID: 27906197 PMCID: PMC5334277 DOI: 10.1038/jp.2016.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 12/02/2022]

Abstract

OBJECTIVE

The critically ill, premature patients of neonatal intensive care units are susceptible to venous thrombosis, an adverse event associated with short- and long-term morbidity. Venous thrombosis is frequently treated with low-molecular-weight heparins (LMWHs) such as enoxaparin, but optimal dosing of LMWH must balance the morbidity of venous thrombosis with the potential adverse affects of anticoagulation. The optimal dosing of enoxaparin for premature infants is unclear. The objective of this study was to describe enoxaparin therapy and follow-up in critically ill neonates diagnosed with venous thrombosis.

STUDY DESIGN

Retrospective medical record review in the neonatal intensive care unit (NICU) in a single tertiary care institution. Infants with venous thrombosis diagnosed in the NICU were identified using preexisting quality improvement lists and medical records.

RESULTS

Twenty-six infants with 30 venous thromboses were identified with a median gestational age of 31 weeks at birth. Eighteen (69%) infants received enoxaparin for venous thrombosis during their hospitalization, beginning with a median dose of 1.5 mg kg^-1 every 12 h. This dose was increased to a median of 2.1 mg kg^-1 every 12 h to achieve target anti-factor Xa levels. The target dose was significantly higher in patients with a postmenstrual age of <37 weeks. Enoxaparin treatment was documented after discharge in 12 patients, continuing for a median of 99 days. Four patients died during hospitalization and their deaths were not attributable to venous thrombosis or anticoagulation complication. Follow-up documentation between 6 and 24 months after venous thrombosis diagnosis revealed no major morbidity of venous thrombosis or enoxaparin therapy.

CONCLUSION

Our data reinforce the relative safety and necessity of enoxaparin doses above 1.5 mg kg^-1 per 12 h in most neonates. This was particularly true for infants at lower postmenstrual age.

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Jaffray J, Bauman M, Massicotte P. The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism. Front Pediatr 2017;5:5. [PMID: 28168186 PMCID: PMC5253371 DOI: 10.3389/fped.2017.00005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022] Open

Haley KM. Neonatal Venous Thromboembolism. Front Pediatr 2017;5:136. [PMID: 28634578 PMCID: PMC5459882 DOI: 10.3389/fped.2017.00136] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open

Abstract

Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE), and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow's triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the coagulation proteins as well as unique pharmacokinetics must also be taken into consideration when recommending VTE treatment. In this review, epidemiology of neonatal VTE, pathophysiology of neonatal VTE with particular attention to the developmental hemostatic system, diagnostic evaluations of neonatal VTE, and treatment guidelines for neonatal VTE will be reviewed.

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Arlikar SJ, Atchison CM, Amankwah EK, Ayala IA, Barrett LA, Branchford BR, Streiff MB, Takemoto CM, Goldenberg NA. Development of a new risk score for hospital-associated venous thromboembolism in critically-ill children not undergoing cardiothoracic surgery. Thromb Res 2015;136:717-22. [DOI: 10.1016/j.thromres.2015.04.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/24/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]