Sage Journals: Discover world-class research

Abstract

Objectives

The aim was to assess the effectiveness and safety of catheter-directed thrombolysis in children with deep venous thrombosis and to evaluate its long-term effect.

Method and results

EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute deep venous thrombosis patients received thrombolysis. Following title and abstract screening, seven cohort studies with a total of 183 patients were identified. Technical success was 82% and superior in regional rather than systemic thrombolysis (p < 0.00001). One cohort study identified significant difference in thrombus resolution at one year between thrombolytic and anticoagulant groups (p = 0.01). The complication rate was low, with incidence rates of major bleeding, pulmonary embolism and others at 2.8%, 1.8% and 8.4%, respectively. The overall post-thrombotic syndrome rate was 12.7%. The incidence of re-thrombosis ranged from 12.3% to 27%.

Conclusion

Thrombolysis for paediatric deep venous thrombosis is an effective and relatively safe therapeutic option, lowering the incidence of post-thrombotic syndrome and deep venous thrombosis recurrence.

Keywords

Thrombolysis children paediatric deep venous thrombosis post-thrombotic syndrome systematic review

Get full access to this article

View all access options for this article.

References

Leary

Harrod

de Alarcon

et al.

Low-dose systemic thrombolytic therapy for deep vein thrombosis in pediatric patients. J Pediatr Hematol Oncol 2010; 32: 97–102.

Kearon

Akl

Ornelas

et al.

Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149: 315–352.

Monagle

Chan

AKC

Goldenberg

et al.

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 2012; 141: e737S–e801S.

Wells

Forster

. Thrombolysis in deep vein thrombosis: is there still an indication? Thromb Haemost 2001; 86: 499–508.

Goldhaber

Meyerovitz

Green

et al.

Randomized controlled trial of tissue plasminogen activator in proximal deep venous thrombosis. Am J Med 1990; 88: 235–240.

Turpie

Levine

Hirsh

et al.

Tissue plasminogen activator (rt-PA) vs heparin in deep vein thrombosis. Results of a randomized trial. Chest 1990; 97: 172S–175S.

Verhaeghe

Besse

Bounameaux

et al.

Multicenter pilot study of the efficacy and safety of systemic rt-PA administration in the treatment of deep vein thrombosis of the lower extremities and/or pelvis. Thromb Res 1989; 55: 5–11.

Greene

Goldenberg

. Deep vein thrombosis: thrombolysis in the pediatric population. Semin Intervent Radiol 2012; 1: 36–43.

Andrew

Marzinotto

Pencharz

et al.

A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home. J Pediatr 1995; 126: 358–363.

10.

Moher

Liberati

Tetzlaff

et al.

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097. https://doi.org/10.1371/journal.pmed.1000097–e1000097. https://doi.org/10.1371/journal.pmed.1000097.

11.

Higgins JPT and Altman DG. Assessing risk of bias in included studies. In: Higgins JPT and Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011, pp. 187–241.

12.

Goldenberg

Branchford

Wang

et al.

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 2011; 22: 121–132.

13.

Wang

Hays

Balasa

et al.

Low-dose tissue plasminogen activator thrombolysis in children. J Pediatr Hematol Oncol 2003; 25: 379–386.

14.

Goldenberg

Durham

Knapp-Clevenger

et al.

A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. Blood 2007; 110: 45–53.

15.

Knöfler

Dinger

Kabus

et al.

Thrombolytic therapy in children – clinical experiences with recombinant tissue-plasminogen activator. Semin Thromb Hemost 2001; 27: 169–174.

16.

Dandoy

Kukreja

Gruppo

et al.

Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis. Pediatr Radiol 2015; 45: 719–726.

17.

Gaballah

Shi

Kukreja

et al.

Endovascular thrombolysis in the management of iliofemoral thrombosis in children: a multi-institutional experience. J Vasc Interv Radiol 2016; 27: 524–530.

18.

Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed 25 September 2017).

19.

Yee

Chan

AKC

Williams

et al.

Varied opinions on thrombolysis for venous thromboembolism in infants and children: findings from a survey of pediatric hematology-oncology specialists. Pediatr Blood Cancer 2009; 53: 960–966.

20.

Albisetti

. Thrombolytic therapy in children. Thromb Res 2006; 118: 95–105.

21.

Jaff

McMurtry

Archer

et al.

Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123: 1788–1830.

22.

Manco-Johnson

Nuss

Hays

et al.

Combined thrombolytic and anticoagulant therapy for venous thrombosis in children. J Pediatr 2000; 136: 446–453.

23.

Manco-Johnson

. Postthrombotic syndrome in children. Acta Haematol 2006; 115: 207–213.

24.

Kuhle

Koloshuk

Marzinotto

et al.

A cross-sectional study evaluating post-thrombotic syndrome in children. Thromb Res 2003; 111: 227–233.

25.

Goldenberg

Knapp-Clevenger

Manco-Johnson

. Elevated plasma factor VIII and d-dimerlevels as predictors of poor outcome of thrombosis in children. J Vasc Surg 2005; 41: 176–176.

26.

Kumar

Rodriguez

Matsumoto

JMS

et al.

Health-related quality of life in children and young adults with post-thrombotic syndrome: results from a cross-sectional study. Pediatr Blood Cancer 2014; 61: 546–551.

27.

Vedantham

Goldhaber

Kahn

et al.

Rationale and design of the ATTRACT study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J 2013; 165: 523–530.e3.

28.

Monagle

Michelson

Bovill

et al.

Antithrombotic therapy in children. Chest 2001; 119: 344S–370S.

29.

Manco-Johnson MJ, Grabowski EF, Hellgreen M, et al. Recommendations for tPA thrombolysis in children, https://c.ymcdn.com/sites/www.isth.org/resource/group/13390e81-9b4b-479f-a449-2b66ad574ffd/official_communications/perinataltpa.pdf (2002, accessed 11 December 2017).

30.

Vignolo

Brignone

Mascagni

et al.

Influence of age, sex and growth variables on phalangeal quantitative ultrasound measures: a study in health children and adolescent. Calcif Tissue Int 2003; 72: 681–688.

31.

Diaz

Campbell

Moursi

et al.

Delayed manifestation of abdominal aortic stenosis in a child presenting 10 years after blunt abdominal trauma. J Vasc Surg 2006; 44: 1104–1106.

32.

Soosainathan

Moore

Gohel

et al.

Scoring systems for the post-thrombotic syndrome. J Vasc Surg 2013; 57: 254–261.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.26 MB

A systematic review of paediatric deep venous thrombolysis

Abstract

Objectives

Method and results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material