Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study

Pelland‐Marcotte, Marie‐Claude; Tucker, Catherine M.; Klaassen, A. A. G.; Avila, Laura; Amid, Ali; Amiri, Nour; Williams, Suzan; Halton, Jacqueline; Brandão, Leonardo R.

doi:10.1016/s2352-3026(18)30224-2

Cited by 41 publications

(47 citation statements)

References 30 publications

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“…We also observed a greater proportion of male sex in patients with PE. Male predominance in PE has not been previously reported in children or young adults without malignancies 16,23 . To date, no other studies have focused on PE in pediatric and young adult ALL; thus, our finding needs to be confirmed and should be interpreted with caution due to few observations and limited statistical power in our study.…”

Section: Discussionmentioning

confidence: 46%

“…Male predominance in PE has not been previously reported in children or young adults without malignancies. 16,23 To date, no other studies have focused on PE in pediatric and young adult ALL; thus, our finding needs to be confirmed and should be interpreted with caution due to few observations and limited statistical power in our study. In a study by Prasca et al, 22 obesity was a significant risk factor to DVT in children with ALL.…”

Section: Discussionmentioning

confidence: 67%

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Pulmonary embolism in acute lymphoblastic leukemia — An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol

Tuckuviene

Bjerg

Jónsson

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Pulmonary embolism (PE) is a serious complication of acute lymphoblastic leukemia (ALL). We examined the cumulative incidence and clinical presentation of PE in a well‐defined cohort of patients with ALL aged 1‐45 years treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. Methods As part of the mandatory toxicity reporting of NOPHO ALL2008, thromboembolism including PE was reported consecutively. The cumulative incidence of first‐time PE was calculated using the Aalen‐Johansen estimator during a 2.5‐year period from ALL diagnosis. We used Fisher’s exact test to examine categorical variables and Cox logistic regression to estimate hazard ratios (HRs) for PE. Results PE was diagnosed in 32 of 1685 patients. The 2.5‐year cumulative incidence of first‐time PE increased with age: 0.43% (95% CI, 0.18‐1.03) in children aged 1‐9 years, 3.28% (95% CI, 1.72‐6.22) in children aged 10‐17 years, and 7.22% (95% CI, 4.61‐11.21) in adults aged 18‐45 years. The majority of PEs, 78% (25/32), occurred during asparaginase treatment. HRs adjusted for age and sex were associated with male sex (HR, 2.4; 95% CI, 1.0‐5.6) and older age (10‐17 years: HR 7.5; 95% CI, 2.5‐22.2), 18‐45 years: HR, 16.5; 95% CI, 6.1‐44.5). In two‐thirds of the patients (63%; 17/27), PE and its treatment had no impact on the administered doses of asparaginase. PE‐associated 30‐day mortality was 9.4% (95% CI, 1.9‐25.0). Conclusions Awareness of PE is warranted during ALL treatment. Larger multicenter studies are needed to examine predictors of PE in ALL.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 67%

Pulmonary embolism in acute lymphoblastic leukemia — An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol

Tuckuviene

Bjerg

Jónsson

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…Additionally, 1 patient was found to have massive tumor embolism, which, to our knowledge, has only been reported in case reports. 3,[8][9][10] In a recent study from Pelland-Marcotte et al, 11 researchers compared 49 pediatric patients with MPE and SMPE combined versus patients with low-risk PE at 2 centers in Canada over a similar time period. Compared with this study, our cohort appeared to have lower proportions of infants ,1 year, cardiac disease, and presence of central venous catheters.…”

Section: Discussionmentioning

confidence: 99%

“…Pelland-Marcotte et al 11 showed that the adult PE severity index and simplified PE severity index were challenging to interpret in the pediatric population because of younger age and lower prevalence of comorbidities. They suggest that variables such as age ,1 year and presence of a central venous catheter should be considered for a pediatric predictive tool.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Massive and Submassive Pulmonary Embolism: A Single-Center Experience

Ross

Shih

Kleinman

et al. 2020

Hospital Pediatrics

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To describe and compare patient and event characteristics and outcomes in pediatric massive pulmonary embolism (MPE) and submassive pulmonary embolism (SMPE). METHODS: A retrospective cohort study at a quaternary-care pediatric hospital was conducted. Patients age ,19 years with MPE (acute pulmonary embolism [PE] with cardiac arrest, hypotension, or compensated shock due to PE) or SMPE (right ventricular strain due to acute PE) between January 1997 and June 2019 were included. RESULTS: Thirty-three patients were identified, including 9 (27%) patients with MPE and 24 (73%) patients with SMPE. The most commonly identified risk factor was use of oral contraceptive pills in 16 (49%) patients. Six (18%) patients died, 3 (9%) of which were PE-related deaths. Before PE, patients with MPE were more likely to be hospitalized (89% vs 13%, P , .001), have major comorbidities (89% vs 25%, P 5 .002), central venous catheters (67% vs 17%, P 5 .01), critical illness (56% vs 8%, P 5 .009), immobility (67% vs 13%, P 5 .005), and be postoperative (44% vs 4%, P 5 .01). MPE patients were also more likely to die before discharge (56% vs 4%, P 5 .003). Both groups were equally likely to have primary reperfusion attempts (78% of MPE versus 67% of SMPE, P 5 .69). CONCLUSIONS: Pediatric MPE and SMPE differed in presentation, comorbidities, and risk factors, many of which were associated with hospitalization status. Pediatric-specific studies are warranted to determine risk assessment and management strategies, which may differ from adult guidelines.

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“…Upon our review of the literature, we identified 15 patients with submassive PE from four retrospective cohort studies who had undergone CDT (including the NCH cohort; Supporting Information Table S2). CDT was well tolerated with only one patient developing a mild gastrointestinal bleed that was medically managed. Additionally, all 15 patients had normalization of right ventricular function on post‐intervention echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

Belsky

Warren

Stanek

et al. 2019

Pediatric Blood & Cancer

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Incidence of venous thromboembolism, including pulmonary embolism (PE), continues to rise in children. Optimum management of submassive PE is unclear. The principal objective of this retrospective study was to investigate the radiological and clinical outcomes in children with submassive PE treated with catheter‐directed thrombolysis (CDT). Five patients underwent six episodes of CDT. No patient developed major/clinically relevant non‐major bleeding. Most patients had complete radiological thrombus resolution and no patient had evidence of chronic thromboembolic pulmonary hypertension. There is an urgent need for larger prospective cohort studies/randomized controlled trials to investigate the role of CDT in pediatric PE.

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Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study

Cited by 41 publications

References 30 publications

Pulmonary embolism in acute lymphoblastic leukemia — An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol

Pulmonary embolism in acute lymphoblastic leukemia — An observational study of 1685 patients treated according to the NOPHO ALL2008 protocol

Pediatric Massive and Submassive Pulmonary Embolism: A Single-Center Experience

Catheter‐directed thrombolysis for submassive pulmonary embolism in children: A case series

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