Venous thromboembolism in pediatric patients with acute lymphoblastic leukemia under chemotherapy treatment. Risk factors and usefulness of thromboprophylaxis. Results of LAL‐SEHOP‐PETHEMA‐2013

Abstract

Introduction Symptomatic venous thromboembolism (VTE) is diagnosed in 3%–14% of patients during pediatric acute lymphoblastic leukemia (ALL) therapy. There are well‐known risk factors, but the role of others as inherited thrombophilia is still controversial. Prophylaxis with low molecular weight heparin (LMWH) has been described, but its use is not globally accepted. Methods A retrospective multicentric study in ALL patients 1–18 years old following SEHOP‐PETHEMA‐2013 treatment guideline was performed to evaluate VTE rate, anticoagulant treatment, outcome, risk factors, and safety and usefulness of LMWH administration as primary thromboprophylaxis in children with inherited thrombophilia. Results A total of 652 patients were included in the study. VTE incidence was 8.7%. Most of the cases occurred during induction therapy associated with central venous catheter. Univariant analysis showed that family history of thrombosis, presence of mediastinal mass, high‐risk treatment group, and inherited thrombophilia were statistically significant risk factors. LMWH administration seemed to decrease VTE rate in patients with inherited thrombophilia and those with T‐cell ALL phenotype. Conclusion Most of the VTE cases occurred in patients without inherited thrombophilia, but when it is present, the VTE risk is higher. LMWH administration was useful to decrease VTE in these patients.

Risk factors and clinical impact of thrombosis during induction chemotherapy for pediatric acute lymphoblastic leukemia: A report from CYP‐C

“…have described that catheter-related venous TEs occurring in induction were associated with an increase in catheter size/body surface ratio. 43 Furthermore, several authors have reported, in concordance with our results, that TE occurring at any point during ALL treatment was associated with more advanced age, T-cell immunophenotype, and high-risk treatment protocols, 21,23,24,32,44,45 in addition to other risk factors such as prolonged exposure to asparaginase and prednisone (compared to dexamethasone). 7 Important factors might contribute to the increased risk of TE ind in these subgroups, including the elevated white cell count at presentation and increased catheter size/ body size ratio for infants, and the use of anthracyclines in children with high-risk and T-cell ALL.…”

“…In a meta‐analysis of 17 prospective studies, Caruso and colleagues have reported that approximately 4.8% (95% CI: 3.7–6.0%) of patients developed TE ind 7 . Similarly, others have reported rates of TE ind ranging between 4.1 and 7.0% of patients 19,23,42–44 . Our somewhat lower incidence rate might be attributable to the stringent definition of TE (grade 3 and above) used in CYP‐C, our study population of children aged up to 14 years old (as the risk of TE increases in adolescents and young adults) as well as factors specific to the Canadian pediatric oncology population, such as approaches to detection methods and cancer treatment protocols.…”

“…7 Similarly, others have reported rates of TE ind ranging between 4.1 and 7.0% of patients. 19,23,[42][43][44] Our somewhat lower incidence rate might be attributable to the stringent definition of TE (grade 3 and above) used in CYP-C, our study population of children aged up to 14 years old (as the risk of TE increases in adolescents and young adults) as well as factors specific to the Canadian pediatric oncology population, such as approaches to detection methods and cancer treatment protocols. Alternatively, it is possible that some toxicities were not captured during data abstraction but, as CYP-C has restricted its definition to the most severe toxicities, we do not suspect a high rate of missing data.…”

Risk Factors of Venous Thromboembolism in Inpatients With Colorectal Cancer in China

“…The incidence of VTE in CRC patients with PICC was significantly higher than that in patients without PICC, which was consistent with the results of previous studies. [22][23][24] The catheter was placed in the venous lumen, resulting in destruction of vascular endothelial cells, hemodynamic changes, and blood stasis. By upsetting the balance of the Virchow triad, these factors create a hypercoagulable state that increases the chance of thrombosis.…”

“…10,13,22,32 PICC was recognized as an independent risk factor for thrombosis, the behavior leads to a hypercoagulable state of the blood and increases the risk of thrombosis by disrupting the Virchow triad. 23,24 Chemotherapeutic drugs can inhibit the synthesis of prostacylin, thrombomodulin, heparan sulfate, tissue factor pathway inhibitors, and plasminogen activator, thus facilitating the formation of venous thrombosis.…”