Low‐dose warfarin for the prevention of central line‐associated thromboses in children with malignancies—a randomized, controlled study

Ruud, Ellen; Holmstrøm, Henrik; Lange, Charlotte de; Hogstad, Ellen M.; Wesenberg, Finn

doi:10.1080/08035250600729092

Cited by 112 publications

(103 citation statements)

References 29 publications

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“…However, studies of low-dose anticoagulation in children with various conditions have yielded inconclusive results, and studies on CVST have not been done. 478,479 Recommendations for the Use of Warfarin in Children With Stroke…”

Section: Warfarinmentioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

872

377

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Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

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Section: Warfarinmentioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

Stroke

872

377

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“…21 By contrast, evidence for efficacy and safety of anticoagulant primary prophylaxis against VTE in hospitalized children is largely lacking. The few clinical trials that have evaluated anticoagulant prevention against VTE in hospitalized children, 22 and those that have involved both inpatient and outpatient settings, 23,24 have generally failed to show efficacy; this is likely due in large part to the need for greater risk-stratification of these populations (pediatric cardiac surgery patients with a central venous catheter, pediatric cancer patients with a central venous catheter, etc.). The recent findings of Raffini and colleagues from the Children's Hospital of Philadelphia, demonstrating increased use of VTE prophylaxis in high-risk patients by using risk-based guidelines, 25 are a testament to the importance of risk evaluation as a basis for appropriate prevention strategies.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Branchford¹,

Mourani²,

Bajaj³

et al. 2011

Haematologica

100

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BackgroundStudies evaluating risk factors for in-hospital venous thromboembolism in children are limited by quality assurance of case definition and/or lack of controlled comparison. The objective of this study is to determine risk factors for the development of in-hospital venous thromboembolism in children. Design and MethodsIn a case-control study at The Children's Hospital, Colorado, from 1 st January 2003 to 31 st December 2009 we employed diagnostic validation methods to determine pediatric in-hospital venous thromboembolism risk factors. Clinical data on putative risk factors were retrospectively collected from medical records of children with International Classification of Diseases, 9th edition codes of venous thromboembolism at discharge, in whom radiological reports confirmed venous thromboembolism and no signs/symptoms of venous thromboembolism were noted on admission. ResultsWe verified 78 cases of in-hospital venous thromboembolism, yielding an average incidence of 5 per 10,000 hospitalized children per year. Logistical regression analyses revealed that mechanical ventilation, systemic infection, and hospitalization duration of five days or over were statistically significant, independent risk factors for in-hospital venous thromboembolism (OR=3. ConclusionsThese data indicate that risk of in-hospital venous thromboembolism in children with this risk factor combination may exceed that of hospitalized adults in whom prophylactic anticoagulation is indicated. Substantiation of these findings via multicenter studies could provide the basis for future risk-stratified randomized control trials of pediatric venous thromboembolism prevention.

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“…Benefit has not been shown in randomised studies even in high-risk subgroups such as children with malignancy. A study using warfarin was terminated prematurely because of lack of efficacy although few children attained a therapeutic International Normalised Ratio (INR) during the study (Ruud et al, 2006b). Routine anticoagulation prophylaxis for children with CVLs is not recommended .…”

Section: Primary Prophylaxismentioning

confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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Low‐dose warfarin for the prevention of central line‐associated thromboses in children with malignancies—a randomized, controlled study

Abstract: Our randomized study of low-dose oral anticoagulation for the prevention of CVL-related asymptomatic VTE in children with cancer did not show any benefit of warfarin adjusted to maintain INR between 1.3 and 1.9.

Cited by 112 publications

References 29 publications

Management of Stroke in Infants and Children

Management of Stroke in Infants and Children

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

Aspects of anticoagulation in children

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