Tina Biss1, Raza Alikhan2, Jeanette Payne3, Jayanthi Alamelu4, Michael Williams5, Michael Richards6, Mary Mathias7, Oliver Tunstall8, Elizabeth Chalmers9. 1. Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 2. Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, UK. 3. Department of Haematology, Sheffield Children's Hospital, Sheffield, UK. 4. Department of Haematology, Evelina London Children's Hospital, London, UK. 5. Department of Haematology, Birmingham Children's Hospital NHS Trust, Birmingham, UK. 6. Department of Paediatric Haematology, Leeds Children's Hospital, Leeds, UK. 7. Haematology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. 8. Department of Haematology, The University Hospitals Bristol NHS Trust, Bristol, UK. 9. Department of Haematology, Royal Hospital for Children, Glasgow, UK.
Abstract
OBJECTIVE: Risk assessment for venous thromboembolism (VTE) and thromboprophylaxis in those with risk factors is established in adult practice. Evidence to support efficacy and safety of this approach in adolescents is lacking. We aimed to describe thrombotic risk factors and to determine the proportion of potentially preventable events in a retrospective cohort study of adolescents with VTE. DESIGN, SETTING AND PATIENTS: Data were collected between 2008 and 2014 from eight tertiary UK centres. Qualifying events were radiologically confirmed VTE in subjects aged 12-17 years. Central venous line-related upper venous system events were excluded. RESULTS: 76 cases were identified, 41 males, median age 15 years. Frequent risk factors were: reduced mobility, 45%; thrombophilia, 24%; malignancy, 20%; surgery, 18%; combined oral contraceptive pill, 12%; congenital venous anomaly, 5%. 28 (37%) had no significant underlying diagnosis and no provoking event/hospitalisation, presenting as outpatients with VTE which was considered 'unpreventable'. Of 48 where there had been opportunity for risk assessment, chemical thromboprophylaxis was not indicated in 26 and was contraindicated in 8. 14/76 (18%) had an indication to consider thromboprophylaxis and no contraindication. Of these, four had cerebral palsy, five malignancy and two inflammatory bowel disease. All had reduced mobility with recent surgery in eight. Four received chemical thromboprophylaxis prior to presentation. CONCLUSIONS: Among a cohort of adolescents with VTE, a small proportion (13%) had an indication to consider chemical thromboprophylaxis but did not receive it. VTE risk assessment and prevention should focus on adolescents with immobility or surgery, particularly in those with malignancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: Risk assessment for venous thromboembolism (VTE) and thromboprophylaxis in those with risk factors is established in adult practice. Evidence to support efficacy and safety of this approach in adolescents is lacking. We aimed to describe thrombotic risk factors and to determine the proportion of potentially preventable events in a retrospective cohort study of adolescents with VTE. DESIGN, SETTING AND PATIENTS: Data were collected between 2008 and 2014 from eight tertiary UK centres. Qualifying events were radiologically confirmed VTE in subjects aged 12-17 years. Central venous line-related upper venous system events were excluded. RESULTS: 76 cases were identified, 41 males, median age 15 years. Frequent risk factors were: reduced mobility, 45%; thrombophilia, 24%; malignancy, 20%; surgery, 18%; combined oral contraceptive pill, 12%; congenital venous anomaly, 5%. 28 (37%) had no significant underlying diagnosis and no provoking event/hospitalisation, presenting as outpatients with VTE which was considered 'unpreventable'. Of 48 where there had been opportunity for risk assessment, chemical thromboprophylaxis was not indicated in 26 and was contraindicated in 8. 14/76 (18%) had an indication to consider thromboprophylaxis and no contraindication. Of these, four had cerebral palsy, five malignancy and two inflammatory bowel disease. All had reduced mobility with recent surgery in eight. Four received chemical thromboprophylaxis prior to presentation. CONCLUSIONS: Among a cohort of adolescents with VTE, a small proportion (13%) had an indication to consider chemical thromboprophylaxis but did not receive it. VTE risk assessment and prevention should focus on adolescents with immobility or surgery, particularly in those with malignancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: C Heleen van Ommen; Manuela Albisetti; Mohir Bhatt; Marianne Bonduel; Brian Branchford; Elizabeth Chalmers; Anthony Chan; Neil A Goldenberg; Susanne Holzhauer; Paul Monagle; Ulrike Nowak-Göttl; Shoshana Revel-Vilk; Gabriela Sciuccatie; Nongnuch Sirachainan; Christoph Male Journal: J Thromb Haemost Date: 2021-04 Impact factor: 5.824
Authors: Matteo Luciani; Manuela Albisetti; Branislav Biss; Lisa Bomgaars; Martina Brueckmann; Elizabeth Chalmers; Savion Gropper; Jacqueline M L Halton; Ruth Harper; Fenglei Huang; Ivan Manastirski; Lesley G Mitchell; Igor Tartakovsky; Bushi Wang; Leonardo R Brandão Journal: Res Pract Thromb Haemost Date: 2018-04-24