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Current practice perspectives on the management of thrombosis in children with renal insufficiency: The results of a survey of pediatric hematologists in North America
Author(s) -
Sharathkumar Anjali Alatkar
Publication year - 2008
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21653
Subject(s) - medicine , thrombophilia , thrombosis , pediatrics , low molecular weight heparin , intensive care medicine , venous thrombosis , population , environmental health
Background No guidelines exist for the management of venous thromboembolic events (VTE) in children with renal insufficiency (RI). Objective To define current practice patterns of VTE management in children with RI. Methods An online multiple choice survey encompassing general questions/clinical scenarios related to thrombosis in RI. Study participants: Pediatric hematologists who were members of Hemophilia and Thrombosis Research Society (HTRS) of North America. Results Response rate was 54% (39/75). VTE was perceived as the major hemostatic problem in children with RI by half (20/39) of respondents. All respondents used anticoagulation for treatment of VTE while 56% used it for prophylaxis of VTE in this population. Management practices varied with respect to choice of anticoagulants employed, consideration of prophylactic anticoagulation, and evaluation for hereditary thrombophilia. Low molecular weight heparin was perceived as a safe anticoagulation for VTE treatment by 77% of respondents given that anti‐factor Xa monitoring was performed to assess bioaccumulation in RI. Thromboprophylaxis was considered for preventing thrombosis at central venous catheter, renal allo‐graft and arterio‐venous fistula in the context of previous history of thrombosis and congenital/acquired thrombophilia. The majority (>70%) would treat life‐threatening emergencies such as superior vena cava syndrome with fibrinolytics despite RI. Conclusions This pediatric study documents that substantial variability existed among pediatric hemologists with respect to VTE management in children with RI. Larger studies are required to better define the epidemiology and management of VTE in children with RI including the value of screening for underlying hereditary thrombophilia. Pediatr Blood Cancer 2008;51:657–661. © 2008 Wiley‐Liss, Inc.