Clinical importance of prothrombotic risk factors in pediatric patients with malignancy – impact of central venous lines

Knöfler, Ralf; Siegert, E.; Lauterbach, I.; Taut-Sack, Heike; Siegert, Gabriele; Gehrisch, S.; Müller, Dirk; Rupprecht, E; Kabus, Maria

doi:10.1007/pl00014342

Cited by 63 publications

(56 citation statements)

References 4 publications

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“…Another study found that 32% of patients who had CVC thromboses had diagnoses of a hypercoagulable state; most had elevated anticardiolipin antibody levels, but there was no greater incidence of prothrombin 20210A mutation, Factor V Leiden, protein C deficiency, or protein S deficiency [62]. In a study in children, however, 63% of those with CVC thromboses did have an inherited risk factor, most of whom were compound heterozygotes [36]. In a related study, this higher risk for CVC thrombosis appeared to occur only in children with acute lymphoblastic leukemia [38].…”

Section: Patientmentioning

confidence: 96%

“…In those that are symptomatic, symptoms include arm/neck/head swelling or pain, headache, numbness of the extremity, erythema of the extremity, phlegmasia, venous distention, and jaw pain. Table 3 lists the studies in which patients with CVCs developed symptoms and then had clots in the affected blood vessel documented by venogram or ultrasound [22,25,[27][28][29][30][31][32][33][34][35][36][37][38][39]. On average, 12% of all patients with CVCs developed symptomatic thrombi but there was a wide range, from 5%-41% of all CVC insertions.…”

Section: Cvc-related Blood Vessel Thrombosis (Dvt)mentioning

confidence: 99%

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Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

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Section: Patientmentioning

confidence: 96%

Section: Cvc-related Blood Vessel Thrombosis (Dvt)mentioning

confidence: 99%

Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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“…15,21 -23 In addition, there are numerous reports of PT G20210A in combination with another risk factor contributing to thrombophilia. 22,24 Treatment of intracardiac thrombi has included surgical intervention, antiplatelet agents, thrombolytics and anticoagulants. In the neonatal period, surgery and thrombolytics are generally reserved for life-threatening thrombi.…”

Section: Discussionmentioning

confidence: 99%

Tricuspid Valve Thrombus and Pulmonary Embolus in an Infant with Homozygous Thermolabile Methylenetetrahydrofolate Reductase and Heterozygous Prothrombin G20210A Variant

2003

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We describe an unusual and interesting case of a full-term infant presenting at 7 days of life with HSV pneumonitis and a tricuspid valve thrombus ultimately requiring extracorporeal membrane oxygenation. The infant subsequently developed a pulmonary embolus. The infant was found to be heterozygous for the prothrombin G20210A mutation and homozygous for the methylenetetrahydrofolate reductase C667T mutation. The patient was treated with low molecular weight heparin for a total of 3 months and has not had a recurrent thrombosis. This case illustrates that a combination of congenital and acquired thrombophilic risk factors can contribute to a significant thrombotic event.

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“…Результаты различных исследований показывают, что наиболее часто ВТ встре-чаются у детей с лимфомами (21,05 %), саркомами (15,62 %) и опухолью Вильмса (42,50 %). При остром лимфобластном лейкозе ВТ выявляются в 10,89 % слу-чаев [3][4][5][6].…”

Section: обзор литературыunclassified

Portal vein thrombosis in a patient with a malignant rhabdoid tumor of the liver (Case report)

Наумова¹

2015

Ross. ž. det. gematol. onkol.

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Clinical importance of prothrombotic risk factors in pediatric patients with malignancy – impact of central venous lines

Cited by 63 publications

References 4 publications

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Tricuspid Valve Thrombus and Pulmonary Embolus in an Infant with Homozygous Thermolabile Methylenetetrahydrofolate Reductase and Heterozygous Prothrombin G20210A Variant

Portal vein thrombosis in a patient with a malignant rhabdoid tumor of the liver (Case report)

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