Treatment of thrombosis in newborns and infants

Česká verzia

Authors: O. Zapletal; J. Máchal; J. Blatný
Authors place of work: Oddělení dětské hematologie FN Brno a LF MU Brno
Published in the journal: Čes-slov Pediat 2020; 75 (2): 82-90.
Category: Original Papers

Summary

Introduction: Thrombotic events in childhood are relatively rare; however there has been a rising trend in their incidence. They usually occur as a complication of another disease or its treatment. The single most important risk factor for thrombosis is central venous catheter placement. Current recommendation for treatment and prophylaxis of thrombosis in children are based on 9th ACCP consensus. The treatment strategy differs in some aspects to the treatment of adults. In small children, low-molecular-weight heparins and a more intense therapy are preferred in order to achieve maximum recanalization of affected vessels.

Cohort and methods: Thromboses in children up to 1 year of age, who were treated at the Department of Paediatric Haematology at University Hospital Brno from 2011 to 2018, are presented in this article.

Results: In above mentioned period of time, 30 children of this age were treated. There was a vast majority (almost 90%) of venous thromboses. They were mostly associated with central venous catheter placement (50% of them). All patients were treated with low-molecular-weight heparins. In most of the cases, the treatment was initiated via continuous infusion, later converted to standard subcutaneous administration. The median treatment length was 80 days. In 80% of patients, there was at least partial regression of thrombosis present at the end of the treatment. There was only one adverse event related to the therapy. In general, the treatment was well tolerated by both children and parents.

Conclusion: Diagnosis of thrombotic events in childhood requires an experienced laboratory and imaging. The treatment should be guided by a paediatric haematologist. Currently, low-molecular-weight heparins are the treatment of choice. A well guided therapy combined with the treatment of often underlying diseases has a high probability of thrombosis regression. Standardized treatment guidelines should be available at every department, where thromboses in children are treated.

Keywords:

Infants – thrombosis – newborns – LMWH – catheter-related thrombosis

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