Assessment of the Outcomes Associated with Periprocedural Anticoagulation Management in Children with Acute Lymphoblastic Leukemia

BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy

“…Peri‐operative management of anticoagulant therapy depends on the surgical bleeding risk, the elimination characteristics of the anticoagulant drug and the risk of recurrent VTE during anticoagulant interruption. Based on published pharmacokinetic data, therapeutic dose LMWH should be withheld for at least 24 ho prior to an invasive procedure, including lumbar puncture (LP) (Manco‐Johnson et al , 2006; Payne & Vora, ; Avila et al , ). LMWH can be restarted 4–6 h after an invasive procedure, including LP, provided there are no concerns regarding haemostasis.…”

“…Peri-operative management of anticoagulant therapy depends on the surgical bleeding risk, the elimination characteristics Payne & Vora, 2007;Avila et al, 2014). LMWH can be restarted 4-6 h after an invasive procedure, including LP, provided there are no concerns regarding haemostasis.…”

Effect of Bcl-2-siRNA on proliferation and apoptosis of pediatric acute B lymphoblastic leukemia (A-BLL) cells

“…Acute B lymphocytic leukemia (A-BLL) is the most common pediatric neoplastic disease, wherein the B lymphocytic cell clones proliferate abnormally, the normal hematopoietic components in the marrow are replaced by leukemic cells, and the leukemic cells spread through blood and affect the tissues and organs outside of the marrow (such as liver, spleen, and lymph node), thereby causing the corresponding clinical manifestations and severely threatening the life of pediatric patients (high fatality rate) (Gupta et al, 2013;Avila et al, 2014;Morais et al, 2014). Radioactive rays, and chemicals, viruses, and genetic factors are known to trigger leukemia.…”

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

“…33,34 In one study, 396 LPs were performed in 22 children with ALL on anticoagulation. 33 Low molecular weight heparin (LMWH) was held for 24 h pre-procedure and resumed 6-9 h post-procedure, while heparin infusion was withheld for 4 h pre-procedure and resumed 4-6 h post procedure. The primary outcome was traumatic LP (the presence of >10 red blood cells/μL cerebrospinal fluid), which occurred in 66/396 LPs (16.7%); however, no spinal hematomas occurred.…”

“…Literature on the best management strategy around the time of neuraxial procedures such as LP in patients with cancer is sparse. Two retrospective studies were identified, both in pediatric patients with acute lymphocytic leukemia (ALL) 33,34 . In one study, 396 LPs were performed in 22 children with ALL on anticoagulation 33 .…”