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Pediatric Radiology

Published in:

01-05-2015 | Original Article

Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis

Authors: Christopher E. Dandoy, Kamlesh U. Kukreja, Ralph A. Gruppo, Manish N. Patel, Cristina Tarango

Published in: Pediatric Radiology | Issue 5/2015

Abstract

Background

Our center has developed a multidisciplinary approach to percutaneous endovascular thrombolysis with the goal of improving outcomes in children with thrombosis. There is little data describing the safety and efficacy of endovascular thrombolysis and the frequency of post-thrombotic syndrome after thrombolysis in children.

Objective

Retrospective analysis of children undergoing percutaneous endovascular thrombolysis to determine (1) the safety and efficacy of this procedure and (2) the frequency of the diagnosis of post-thrombotic syndrome after thrombolysis.

Materials and methods

We reviewed the medical and imaging databases for children who underwent percutaneous endovascular thrombolysis for deep venous thrombosis (DVT) between November 2008 and June 2013 at our institution. Demographic data were reviewed for the technical success and complications of thrombolysis and the last assigned post-thrombotic syndrome score using standardized scoring tools.

Results

Forty-one children ages 3 months to 21 years (median age: 15 years; 44% male) underwent percutaneous endovascular thrombolysis between November 2008 and June 2013. Upper extremity DVT occurred in 13 patients (32%); lower extremity DVT occurred in 28 patients (68%). All 41 patients received thrombolysis grading; 90% of those patients achieved greater than 50% thrombus lysis. Twenty-eight patients received formal post-thrombotic syndrome scoring and 4 (14%) met diagnostic criteria for post-thrombotic syndrome. One major bleeding episode and one pulmonary embolism occurred with no long-term sequelae.

Conclusion

Endovascular thrombolysis for DVT in children is safe, effective at thrombus removal and may reduce the incidence of post-thrombotic syndrome. Randomized or larger clinical trials would be needed to determine the long-term benefits of endovascular thrombolysis.

Kukreja K, Gruppo R, Chima R et al (2013) Developing a pediatric endovascular thrombolysis program: a single-center experience. Pediatr Radiol 43:1024–1029CrossRefPubMed

Parasuraman S, Goldhaber SZ (2006) Venous thromboembolism in children. Circulation 113:e12–e16CrossRefPubMed

Raffini L, Huang Y-S, Witmer C et al (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124:1001–1008CrossRefPubMed

Chan AKC, Monagle P (2012) Updates in thrombosis in pediatrics: where are we after 20 years? ASH Educ Prog Book 2012:439–443

Prandoni P, Lensing AWA, Cogo A et al (1996) The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 125:1–7CrossRefPubMed

Goldenberg NA, Donadini MP, Kahn SR et al (2010) Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica 95:1952–1959CrossRefPubMedCentralPubMed

Manco-Johnson MJ (2006) Postthrombotic syndrome in children. Acta Haematol 115:207–213CrossRefPubMed

Kahn SR (2009) How I treat postthrombotic syndrome. Blood 114:4624–4631CrossRefPubMed

Pianta MJ, Thomson KR (2011) Catheter-directed thrombolysis of lower limb thrombosis. Cardiovasc Intervent Radiol 34:25–36CrossRefPubMed

10.

Goldenberg NA, Branchford B, Wang M et al (2011) Percutaneous mechanical and pharmacomechanical thrombolysis for occlusive deep vein thrombosis of the proximal limb in adolescent subjects: findings from an institution-based prospective inception cohort study of pediatric venous thromboembolism. J Vasc Interv Radiol 22:121–132CrossRefPubMedCentralPubMed

11.

Darbari DS, Desai D, Arnaldez F et al (2012) Safety and efficacy of catheter directed thrombolysis in children with deep venous thrombosis. Brit J Haematol 159:376–378CrossRef

12.

Enden T, Haig Y, Kløw N-E et al (2012) Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 379:31–38CrossRefPubMed

13.

Stain M, Schönauer V, Minar E et al (2005) The post-thrombotic syndrome: risk factors and impact on the course of thrombotic disease. J Thromb Haemost 3:2671–2676CrossRefPubMed

14.

Leary SE, Harrod VL, de Alarcon PA et al (2010) Low-dose systemic thrombolitic therapy for deep vein thrombosis in pediatric patients. J Pediatr Hematol Oncol 32:97–102CrossRefPubMedCentralPubMed

15.

Goldenberg NA, Durham JD, Knapp-Clevenger R et al (2007) A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 110:45–53CrossRefPubMedCentralPubMed

16.

Mewissen MW, Seabrook GR, Meissner MH et al (1999) Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 211:39–49CrossRefPubMed

17.

Mitchell LG, Goldenberg NA, Male C et al (2011) Definition of clinical efficacy and safety outcomes for clinical trials in deep venous thrombosis and pulmonary embolism in children. J Thromb Haemost 9:1856–1858CrossRefPubMed

18.

Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e419S–94SCrossRefPubMedCentralPubMed

19.

Vedantham S, Vesely TM, Parti N et al (2002) Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 13:1001–1008CrossRefPubMed

20.

Vedantham S, Thorpe PE, Cardella JF et al (2006) Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 17:435–447CrossRefPubMed

21.

Kahn SR (2009) Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome. J Thromb Haemost 7:884–888CrossRefPubMed

22.

Goldenberg NA, Brandão LR, Journeycake J et al (2012) Definition of post-thrombotic syndrome following lower extremity deep venous thrombosis and standardization of outcome measurement in pediatric clinical investigations. J Thromb Haemost 10:477–480CrossRefPubMed

23.

Villalta S, Bagatella P, Piccioli A et al. (1994) Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Haemostasis 24:158A (abstract)

24.

Vedantham S, Thorpe PE, Cardella JF et al (2009) Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 20:S227–S239CrossRefPubMed

25.

Bjarnason H, Kruse JR, Asinger DA et al (1997) Iliofemoral deep venous thrombosis: safety and efficacy outcome during 5 years of catheter-directed thrombolytic therapy. J Vasc Interv Radiol 8:405–418CrossRefPubMed

26.

Leaker M, Massicotte MP, Brooker LA et al (1996) Thrombolytic therapy in pediatric patients: a comprehensive review of the literature. Thromb Haemost 76:132–134PubMed

27.

Albisetti M (2006) Thrombolytic therapy in children. Thromb Res 118:95–105CrossRefPubMed

28.

Newall F, Browne M, Savoia H et al (2007) Assessing the outcome of systemic tissue plasminogen activator for the management of venous and arterial thrombosis in pediatrics. J Pediatr Hematol Oncol 29:269–273CrossRefPubMed

29.

Gupta AA, Leaker M, Andrew M et al (2001) Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr 139:682–688CrossRefPubMed

30.

Monagle P, Chan AKC, Goldenberg NA et al (2012) Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. Chest 141:e737S–e801SCrossRefPubMedCentralPubMed

31.

Kahn SR, Shbaklo H, Lamping DL et al (2008) Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 6:1105–1112CrossRefPubMed

32.

Kahn SR, Ducruet T, Lamping DL et al (2005) Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med 165:1173–1178CrossRefPubMed

33.

Broholm R, Sillesen H, Damsgaard MT et al (2011) Postthrombotic syndrome and quality of life in patients with iliofemoral venous thrombosis treated with catheter-directed thrombolysis. J Vasc Surg 54:18S–25SCrossRefPubMed

Title: Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis
Authors: Christopher E. Dandoy
Kamlesh U. Kukreja
Ralph A. Gruppo
Manish N. Patel
Cristina Tarango
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 5/2015
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-014-3209-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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