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Pediatric thromboembolism

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https://www.readbyqxmd.com/read/28921890/phase-ii-study-of-dabigatran-in-children-with-venous-thrombosis-pharmacokinetics-safety-and-tolerabilty
#1
J M L Halton, M Albisetti, B Biss, L Bomgaars, M Brueckmann, S Gropper, R Harper, F Huang, M Luciani, H Maas, I Tartakovsky, L G Mitchell
BACKGROUND: The current standard-of-care treatments for pediatric venous thromboembolism (VTE) have limitations. Dabigatran etexilate (DE), a direct thrombin inhibitor, may offer an alternative therapeutic option. OBJECTIVES: To assess the pharmacokinetics (PK), pharmacodynamics (PD), safety and tolerability of DE oral liquid formulation (OLF) in pediatric patients with VTE. PATIENTS/METHODS: Patients who had completed planned treatment with low-molecular-weight heparin or oral anticoagulants for VTE were enrolled in two age groups (2-<12 and 1-<2 years) and received DE OLF based on an age- and weight-adjusted nomogram...
September 16, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28899861/quality-initiative-to-introduce-pediatric-venous-thromboembolism-risk-assessment-for-orthopedic-and-surgery-patients
#2
Laura H Brower, Nathalie Kremer, Katie Meier, Christine Wolski, Molly M McCaughey, Emily McKenna, Jennifer Anadio, Emily Eismann, Erin E Shaughnessy
BACKGROUND AND OBJECTIVES: Pediatric hospital-acquired venous thromboembolism (VTE) is costly, has high morbidity, and is often preventable. The objective of this quality-improvement effort was to increase the percentage of general surgery and orthopedic patients ≥10 years of age screened for VTE risk from 0% to 80%. METHODS: At a freestanding children's hospital, 2 teams worked to implement VTE risk screening for postoperative inpatients. The general surgery team used residents and nurse practitioners to perform screening whereas the orthopedic team initially used bedside nursing staff...
September 12, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28899859/development-of-a-surveillance-system-for-pediatric-hospital-acquired-venous-thromboembolism
#3
Laura H Brower, Erin E Shaughnessy, Ranjit S Chima
BACKGROUND: Pediatric hospital-acquired (HA) venous thromboembolism (VTE) is a vexing problem with improvement efforts hampered by lack of robust surveillance methods to establish accurate rates of HA-VTE. METHODS: At a freestanding children's hospital, a multidisciplinary team worked to develop a comprehensive surveillance strategy for HA-VTE. Starting with diagnosis codes, we implemented complementary detection methods, including clinical and radiology data, to develop a robust surveillance system...
September 12, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28859034/six-weeks-versus-3-months-of-anticoagulant-treatment-for-pediatric-central-venous-catheter-related-venous-thromboembolism
#4
Rowenne Smith, Sophie Jones, Fiona Newall
OBJECTIVE: Central venous catheters (CVCs) are the single most important predisposing factor for the development of pediatric venous thromboembolism (VTE). Treatment recommendations suggest anticoagulation for the duration of 6 weeks to 3 months. This project investigated clinical outcomes associated with 6 weeks compared with 3 months of enoxaparin therapy following diagnosis of a CVC-related VTE. METHODS: This retrospective cohort study enrolled patients aged 18 years and below treated with enoxaparin with/without unfractionated heparin for a radiologically confirmed CVC-related VTE...
August 30, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28815363/the-use-of-natural-language-processing-on-pediatric-diagnostic-radiology-reports-in-the-electronic-health-record-to-identify-deep-venous-thrombosis-in-children
#5
Jorge A Gálvez, Janine M Pappas, Luis Ahumada, John N Martin, Allan F Simpao, Mohamed A Rehman, Char Witmer
Venous thromboembolism (VTE) is a potentially life-threatening condition that includes both deep vein thrombosis (DVT) and pulmonary embolism. We sought to improve detection and reporting of children with a new diagnosis of VTE by applying natural language processing (NLP) tools to radiologists' reports. We validated an NLP tool, Reveal NLP (Health Fidelity Inc, San Mateo, CA) and inference rules engine's performance in identifying reports with deep venous thrombosis using a curated set of ultrasound reports...
August 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28791278/venous-thromboembolism-in-pediatric-vascular-anomalies
#6
REVIEW
Taizo A Nakano, Chadi Zeinati
The presence of a vascular anomaly suggests that capillaries, veins, arteries, and/or lymphatic vessels have demonstrated abnormal development and growth. Often dilated and misshaped, these vessels augment normal flow of blood and lymphatic fluids that increases the overall risk to develop intralesional thrombosis. Abnormal endothelial and lymphoendothelial cells activate hemostasis and hyperfibrinolytic pathways through poorly understood mechanisms, which contribute to the development of localized intravascular coagulopathy...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28774877/how-i-treat-pediatric-venous-thromboembolism
#7
Guy Young
The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly in incidence over the past decade in part as a result of increased recognition of this serious disorder but more so due to the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, compared to adults, this remains a relatively rare disorder and as such large scale clinical trials have not been completed rendering management decisions to be based upon extrapolation from adult data and the experience of the treating physician...
August 3, 2017: Blood
https://www.readbyqxmd.com/read/28742719/pediatric-gastroenterologists-approach-to-venous-thromboembolism-prophylaxis-in-pediatric-inflammatory-bowel-disease
#8
Kimberley Ann Chien, Hoda T Hammad, Linda Gerber, Sujit Sheth, Robbyn Sockolow, Nicole Elena Kucine
The risk of venous thromboembolism (VTE) is significantly increased in inflammatory bowel disease (IBD) patients. For the adult population, prophylaxis guidelines exist to help guide physicians in their management of high-risk IBD patients. While it is known that children with IBD also experience increased rates of VTE, there is no clear consensus on how best to prevent these unwanted complications. We sought to better understand practicing pediatric gastroenterologists' awareness of this issue and practices surrounding prevention of VTE in their pediatric patients...
July 22, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28701841/continuous-renal-replacement-therapy-applications-on-extracorporeal-membrane-oxygenation-circuit
#9
Ayse Filiz Yetimakman, Murat Tanyildiz, Selman Kesici, Esra Kockuzu, Benan Bayrakci
BACKGROUND AND AIMS: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. MATERIALS AND METHODS: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28674685/risk-factors-prophylaxis-and-treatment-of-venous-thromboembolism-in-congenital-heart-disease-patients
#10
REVIEW
Michael Silvey, Leonardo R Brandão
Congenital heart disease (CHD) is a common condition in the pediatric population, affecting up to 1% of all live births (i.e., around 40,000 newborns/year in the United States). Although CHD does have a wide range of severity, by the age of 5 years approximately 80% of patients will require at least one surgical intervention to achieve a complete/palliative cardiac repair. Today, in light of their much-improved surgical survival, the care of these patients focuses on morbidity prevention and/or treatment...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28669107/outcomes-and-costs-of-cardiac-surgery-in-adults-with-congenital-heart-disease
#11
Viviane G Nasr, David Faraoni, Anne Marie Valente, James A DiNardo
Advances in pediatric cardiac surgical and medical care have led to increased survival of patients with congenital heart disease (CHD). Consequently, many CHD patients survive long enough to require cardiac surgery as adults. Using the 2013 Nationwide Inpatient Sample (NIS) database, we compared costs and outcomes for adult patients undergoing surgery for treatment of CHD to a reference population of adults undergoing CABG. Patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) procedure codes...
July 1, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28650356/trending-fibrinolytic-dysregulation-fibrinolysis-shutdown-in-the-days-after-injury-is-associated-with-poor-outcome-in-severely-injured-children
#12
Christine M Leeper, Matthew D Neal, Christine J McKenna, Barbara A Gaines
OBJECTIVE: To trend fibrinolysis after injury and determine the influence of traumatic brain injury (TBI) and massive transfusion on fibrinolysis status. BACKGROUND: Admission fibrinolytic derangement is common in injured children and adults, and is associated with poor outcome. No studies examine fibrinolysis days after injury. METHODS: Prospective study of severely injured children at a level 1 pediatric trauma center. Rapid thromboelastography was obtained on admission and daily for up to 7 days...
September 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28643816/-budd-chiari-syndrome-and-ulcerative-colitis-in-an-adolescent
#13
Federico Marchetti, Martina Mainetti, Michela Giovannini, Cristina Morelli
In patients with inflammatory bowel disease (IBD) there is an increased incidence of thromboembolic events. We report a case of a female, age 14, with a 6 months history of diarrhea with occasional presence of red blood and with a very distended abdomen with evident ascites. The diagnosis was Budd-Chiari syndrome (BCS) in ulcerative colitis (UC). Therapy with subcutaneous low molecular weight heparin, methylprednisolone, mesalazine was started. Clinical and radiological features quickly improved. No thrombophilia abnormality nor other risk factor for thrombosis were detected...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28634578/neonatal-venous-thromboembolism
#14
REVIEW
Kristina M Haley
Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE), and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28586917/toward-the-virtual-benchmarking-of-pneumatic-ventricular-assist-devices-application-of-a-novel-fluid-structure-interaction-based-strategy-to-the-penn-state-12-cc-device
#15
Alessandro Caimi, Francesco Sturla, Bryan Good, Marco Vidotto, Rachele De Ponti, Filippo Piatti, Keefe B Manning, Alberto Redaelli
The pediatric use of pneumatic ventricular assist devices (VADs) as a bridge to heart transplant still suffers for short-term major complications such as bleeding and thromboembolism. Although numerical techniques are increasingly exploited to support the process of device optimization, an effective virtual benchmark is still lacking. Focusing on the 12 cc Penn State pneumatic VAD, we developed a novel fluid-structure interaction (FSI) model able to capture the device functioning, reproducing the mechanical interplay between the diaphragm, the blood chamber, and the pneumatic actuation...
August 1, 2017: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/28584789/anticoagulation-therapy-during-extracorporeal-membrane-oxygenator-support-in-pediatric-patients
#16
REVIEW
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for critically ill patients. Although ECMO is becoming more common, hemorrhagic and thromboembolic complications remain the major causes of death in patients undergoing ECMO treatments. These complications commence upon blood contact with artificial surfaces of the circuit, blood pump, and oxygenator system. Therefore, anticoagulation therapy is required in most cases to prevent these problems. Anticoagulation is more complicated in pediatric patients than in adults, and the foreign surface of ECMO only increases the complexity of systemic anticoagulation...
May 2017: Chonnam Medical Journal
https://www.readbyqxmd.com/read/28565849/myocardial-protective-effects-of-dexmedetomidine-in-patients-undergoing-cardiac-surgery-a-meta-analysis-and-systematic-review
#17
Zheng Gong, Li Ma, Yu-Lin Zhong, Jun Li, Jing Lv, Yu-Bo Xie
Arrhythmias are the common complications following cardiac surgery and contribute to hemodynamic instability, cognitive impairment, thromboembolic events, and congestive heart failure. Prevention of atrial fibrillation following cardiac surgery reduces morbidity and among the many available preventive approaches dexmedetomidine shows many positive effects on cardiovascular stability. Even though many studies indicated the beneficial effects of dexmedetomidine, the power of the analysis and conclusion of these studies is rather weak due to relatively smaller number of patients in these studies...
May 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28540196/significance-of-platelet-count-in-children-admitted-with-bronchiolitis
#18
Amar Al Shibli, Najla Alkuwaiti, May Hamie, Dima Abukhater, Muhammad B Noureddin, Abdulla Amri, Salwa Al Kaabi, Aysha Al Kaabi, Mariam Harbi, Hassib Narchi
AIM: To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis, its association with risk factors, disease severity and thromboembolic complications. METHODS: A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis. Clinical outcomes included disease severity, duration of hospital stay, admission to pediatric intensive care unit, or death. They also included complications of thrombocytosis, including thromboembolic complications such as cerebrovascular accident, acute coronary syndrome, deep venous thrombosis, pulmonary embolus, mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding (spontaneous hemorrhage in the skin, mucous membranes, gastrointestinal, respiratory, or genitourinary tracts)...
May 8, 2017: World Journal of Clinical Pediatrics
https://www.readbyqxmd.com/read/28521068/association-of-outcomes-and-anti-xa-levels-in-the-treatment-of-pediatric-venous-thromboembolism
#19
Jennifer L Fan, Laura E Roberts, Michael E Scheurer, Donald L Yee, Mona D Shah, YoungNa J Lee-Kim
BACKGROUND: There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes. OBJECTIVE: To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment. METHODS: We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin...
November 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28495065/the-miniaturized-pediatric-continuous-flow-device-preclinical-assessment-in-the-chronic-sheep-model
#20
Iki Adachi, Sarah Burki, David Horne, Gil G Costas, Taylor Spangler, Robert Jarvik, John Teal, J Timothy Baldwin, Kurt Dasse, M Patricia Massicotte, Jeff Conger, William E Cohn, Charles D Fraser
BACKGROUND: The Infant Jarvik 2015 is an implantable axial-flow ventricular assist device (VAD) that has undergone the major evolutionary design modifications to improve hemocompatibility. This study was conducted in anticipation of data submission to the US Food and Drug Administration to obtain Investigational Device Exemption approval. METHODS: The VAD was implanted via a left thoracotomy in Barbado sheep (n = 10, 26 (19-34] kg). Anticoagulation was maintained with coumadin, with a target international normalized ratio of greater than the individual sheep's baseline values...
July 2017: Journal of Thoracic and Cardiovascular Surgery
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