Pediatrik tromboza multidisipliner yaklaşım, üçüncü basamak referans merkezin 2 yıllık deneyimi

Year 2020, Volume: 3 Issue: 1, 1 - 4, 26.02.2020

Rumeysa Tuna , Mustafa Bilici Osman Kipoğlu , Orhan Coşkun Zuhal Bayramoğlu , Suheyla Ocak , Deniz Tuğcu , Serap Karaman Ayşegül Ünüvar , Serra Sencer Nur Aydınlı Zerrin Önal Zeynep Yürük Yıldırım Kemal Nişli , Rukiye Eker Ömeroğlu Aygün Dindar Zeynep İnce Demet Demirkol , Mine Çalışkan Zeynep Karakaş

Abstract

Pediatrik tromboz epidemiyolojisi, patofizyolojisi ve tedavi öncelikleri nedeniyle erişkin tromboz yönetiminden çok farklı özelliklere sahiptir. Tromboz teşhisi konan çocuklar, multidisipliner bir ekip tarafından tanı, tedavi ve takip süresince değerlendirilmelidir. Burada pediatrik tromboz hastalarımızın yönetildiği 2 yıllık multidisipliner tromboz konseyi deneyimimizi sunuyoruz. Kasım 2017-Ağustos 2019 tarihleri arasında 61 çocuk (95 başvuru) için tromboz konseyi olgu sunumlarını ve konsey sonuçlarını geriye dönük olarak inceledik. Değerlendirilen hastalarda erkek/kadın oranı 1,54 saptandı, çocuklar ve adolesanlar çoğunluktaydı. Hastaların klinik ve radyolojik durumlarına göre tedavi ve profilaksi süreleri belirlendi. Olgularımız içinde serebral arteriyel ve sinovenöz tromboz olguları daha fazla idi. Kazanılmış risk faktörleri, kalıtsal olanlardan daha fazla olup, infeksiyon ve Faktör VIII yüksekliği sık idi. Otuz dokuz hastaya (%64) farklı süreler boyunca K vitamini antagonistleri, aspirin veya LMVH ile primer veya sekonder profilaksi uygulandı. Pediatrik trombozda kanıta dayalı kılavuzların iyileştirilmesi için tedavi ve profilaksi yönetimi üzerine daha fazla çalışmaya ihtiyaç vardır. Multidisipliner tromboz konseyi komplike pediatrik trombozlu çocuk hastalarda hasta bakımını iyileştirebilir. 

Keywords

Pediatrik tromboz, tedavi, proflaksi, multidisipliner yönetim

Two years experience of a multidisciplinary approach for pediatric thrombosis in a tertiary referral center

Abstract

Pediatric thrombosis has unique characteristics due to its epidemiology, pathophysiology and treatment considerations. Children diagnosed with thrombosis should be evaluated by a multidisciplinary team at the level of diagnosis, treatment, and follow-up. Here we present our 2 years experience of pediatric thrombosis patients with a multidisciplinary thrombosis council management. We retrospectively reviewed case presentations and recommendations of monthly thrombosis council for 61 children (95 admissions) between November 2017 and August 2019. The male/female ratio was 1.54 and children and adolescents were the majority of evaluated 61 patients. Based on patients' clinical and radiological status, treatment and prophylaxis periods were determined. Cerebral arterial and sinovenous thrombosis were more common in our pediatric thrombosis council cases. Acquired risk factors for thrombosis were more common than congenital thrombophilia. Infection and elevated Factor VIII were commonest, respectively. Thirty-nine patients (64%) received primary or secondary prophylaxis with vitamin K antagonists, aspirin or LMVH for different periods. Further studies on treatment and prophylaxis management are needed for the improvement of evidence-based guidelines in pediatric thrombosis. Multidisciplinary councils may improve patient care for pediatric patients with complicated thrombosis. 

Keywords

Pediatric thrombosis, treatment, prophylaxis, multidisciplinary management

References

• 1. Monagle P, Cuello CA, Augustine C, Bonduel M, Brandao LR, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood advances. 2018;2(22):3292-316.
• 2. Newall F, Branchford B, Male C. Anticoagulant prophylaxis and therapy in children: current challenges and emerging issues. Journal of thrombosis and haemostasis : JTH. 2018.
• 3. Chalmers E, Ganesen V, Liesner R, Maroo S, Nokes T, et al. Guideline on the investigation, management and prevention of venous thrombosis in children. British journal of haematology. 2011;154(2):196-207.
• 4. Young G, Albisetti M, Bonduel M, Brandao L, Chan A, et al. Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and metaanalysis of observational studies. Circulation. 2008;118(13):1373-82.
• 5. Mahajerin A, Branchford BR, Amankwah EK, Raffini L, Chalmers E, et al. Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica. 2015;100(8):1045-50.
• 6. Jaffray J, Mahajerin A, Young G, Goldenberg N, Ji L, et al. A multi-institutional registry of pediatric hospital-acquired thrombosis cases: The Children’s Hospital-Acquired Thrombosis (CHAT) project. Thrombosis research. 2018;161:67-72.
• 7. Monagle P. Slow progress. How do we shift the paradigm of thinking in pediatric thrombosis and anticoagulation? Thrombosis research. 2019;173:186-90.
• 8. Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S-e801S.
• 9. Rodger MA, Le Gal G. Who should get long-term anticoagulant therapy for venous thromboembolism and with what? Blood advances. 2018;2(21):3081-7.
• 10. Nowak-Gottl U, van Ommen H, Kenet G. Thrombophilia testing in children: What and when should be tested? Thrombosis research. 2018;164:75-8.