Treatment, survival, and thromboembolic outcomes of thrombotic storm in children

The Journal of Pediatrics
Marilyn J Manco-JohnsonPeter M Mourani

Abstract

To describe the course and management of thrombotic storm in 8 children. Clinical data were collected and analyzed for consecutive children diagnosed with thrombotic storm, aged 6 months to 21 years inclusive, in the context of a single-institution prospective inception cohort study. Thrombotic storm was defined as newly diagnosed multisite venous thromboembolism (VTE) with acute thrombus progression despite conventional or higher than conventional dosing of heparin or low molecular weight heparin. All evaluations and therapies were ordered by the treating physicians in the context of clinical decision making. Eight of the 178 children with VTE enrolled in the cohort between March 2006 and November 2009 were diagnosed with thrombotic storm. Antiphospholipid antibodies were acutely positive in 6 children, of whom heparin-induced thrombocytopenia was confirmed by serotonin release assay in 2 and atypical in 1. One child died. Five children received a direct thrombin inhibitor, titrated to achieve normalization of markedly elevated D-dimer levels. All children were transitioned to fondaparinux or enoxaparin before receiving extended anticoagulation with warfarin. Immunomodulatory therapy was instituted in all children. During foll...Continue Reading

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Citations

Mar 29, 2014·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Michael J KhadaviJane-Anne Emerson
Apr 10, 2015·Current Rheumatology Reports·Cassyanne L AguiarBarry L Myones
Dec 3, 2013·Therapeutic Advances in Musculoskeletal Disease·Cassyanne L Aguiar, Doruk Erkan
Dec 12, 2012·Expert Review of Hematology·Thomas L OrtelJeffery Vance
Jul 17, 2015·Blood·Thomas L OrtelCraig S Kitchens
May 26, 2018·International Journal of Immunopathology and Pharmacology·Jing-Yao MaFang-Yun Wang
Mar 4, 2020·Current Rheumatology Reports·Arzu Soybilgic, Tadej Avcin
Jul 7, 2018·Case Reports in Critical Care·Muhammad Asim RanaKamal Naser
Feb 10, 2021·Journal of Pediatric Hematology/oncology·Ankur K JindalSurjit Singh

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