Are low-molecular-weight heparins safe and effective in children? A systematic review

Klaassen, Irene L. M.; Sol, Jeanine J.; Suijker, Monique H.; Fijnvandraat, Karin; Wetering, M. D. van de; Ommen, C. Heleen van

doi:10.1016/j.blre.2018.06.003

Cited by 26 publications

(29 citation statements)

References 67 publications

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“…Safety concerns, specifically the presumed bleeding risk, are the main reason for paediatric and adult gastroenterologists to be cautious about prescribing prophylactic anticoagulation 68,69 . A systematic review assessing safety and efficacy of thromboprophylaxis in children, showed that major bleeding events occurred in only 0.6% of children (some in neonates) 70 . Studies in children are lacking, but in adults with IBD thromboprophylaxis with LMWH has shown to be safe, even in patients who initially present with rectal bleeding 71,72 .…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

et al. 2021

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Section: Discussionmentioning

confidence: 99%

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

et al. 2021

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“…The advantages of LMWH include predictable pharmacokinetics and minimal monitoring. A recent systematic review revealed LMWH appeared to be safe and effective for therapeutic and prophylactic treatment of venous thromboembolism in children [35]. However, it is not optimal for children because of the need for subcutaneous injections.…”

Section: Discussionmentioning

confidence: 99%

Clinical and genetic features of Chinese pediatric patients with severe congenital protein C deficiency who first presented with purpura fulminans: A case series study and literature review

Tang

Zhang

Yang

et al. 2022

Thrombosis Research

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Introduction: Purpura fulminans (PF) is a hematological emergency that can be caused by severe congenital protein C (PC) deficiency. It has been rarely reported in the Chinese population. We aimed to characterize the clinical and genetic features of Chinese pediatric patients with severe congenital PC deficiency who first presented with PF. Materials and methods: Twelve pediatric patients were diagnosed with severe congenital PC deficiency with PF, which was diagnosed based on our hospital records and previous reports from 1988 to July 2021 in China. We evaluated the clinical and genetic features of these patients. Results: Nine patients (9/12, 75%) had onsets that were observed within the first 48 h after birth. Six patients had a family history of thromboembolism. There was no consanguinity. Other symptoms were intracranial thrombosis or hemorrhage (4, 33.3%), ocular lesions (2, 16.7%), gastrointestinal hemorrhage (2, 16.7%) and kidney infarction before birth (1, 8.3%). All but one of the patients (one case not detected) had a plasma PC activity of <10%. The genetic study indicated that in the eight patients with inherited PC deficiency, two were homozygous, five were compound heterozygous and one was heterozygous for PC deficiency. Conclusion: This is the first and largest case series of Chinese pediatric patients with severe congenital PC deficiency who first presented with PF. It has been shown that treatment with both fresh frozen plasma and anticoagulants is recommended when PC concentrate is not easily available, especially in developing countries.

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“… 68 , 69 A systematic review assessing the safety and efficacy of thromboprophylaxis in children showed that major bleeding events occurred in only 0.6% of children [some in neonates]. 70 Studies in children are lacking, but in adults with IBD thromboprophylaxis with LMWH has been shown to be safe, even in patients who initially present with rectal bleeding. 71 , 72 In future, direct oral anticoagulants may replace the use of LMWH as thromboprophylaxis in children with a VTE, because of the advantage of oral over subcutaneous administration and fewer bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease: A Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

Aardoom

Klomberg

Kemos

et al. 2021

Journal of Crohn's and Colitis

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Background & Aims Guidelines regarding thromboprophylaxis for venous thromboembolisms (VTE) in children with inflammatory bowel disease (IBD) are based on limited paediatric evidence. We aimed to prospectively assess the incidence of VTE in paediatric-onset IBD (PIBD), characterize PIBD patients with VTE, and identify potential IBD-related risk factors. Methods From October 2016 till September 2020, paediatric gastroenterologists prospectively replied to the international Safety Registry, monthly indicating whether they had observed a VTE case in a patient <19 years with IBD. IBD details (type, Paris classification, clinical and biochemical disease activity, treatment) and VTE details (type, location, treatment, outcome) were collected. To estimate the VTE incidence, participants annually reported the number of PIBD patients, data source and catchment area of their center. A systematic literature review and meta-analysis was performed to calculate the VTE incidence in the general paediatric population. Results Participation of 129 PIBD centers resulted in coverage of 24,802 PIBD patients. Twenty cases of VTE were identified (30% Crohn’s disease). The VTE incidence was 3.72 [95%CI 2.27 – 5.74] per 10,000 person-years, 14-fold higher than in the general paediatric population (0.27 [95%CI 0.18-0.38], p<0.001). Cerebral sinus venous thrombosis was most frequently reported (50%). All but one patient had active IBD, 45% were using steroids and 45% hospitalized. No patient received thromboprophylaxis, whereas according to current PIBD guidelines, this was recommended in 4/20 patients. Conclusion There is an increased risk of VTE in the PIBD population compared to the general paediatric population. Awareness of VTE occurrence and prevention should be extended to all PIBD patients with active disease, especially those hospitalized.

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Are low-molecular-weight heparins safe and effective in children? A systematic review

Cited by 26 publications

References 67 publications

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease; a Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

Clinical and genetic features of Chinese pediatric patients with severe congenital protein C deficiency who first presented with purpura fulminans: A case series study and literature review

The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease: A Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry

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