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thrombolysis in children

Hyoung Soo Choi, Chang Won Choi, Heon Min Kim, Hye Won Park
BACKGROUND: While venous thromboembolism (VTE) is uncommon, its incidence is increasing in children. We aimed to evaluate the incidence, risk factors, treatment, and outcome of pediatric VTE cases at a single tertiary hospital in Korea. METHODS: We retrospectively analyzed the records of consecutive pediatric VTE patients admitted to the Seoul National University Bundang Hospital between April 2003 and March 2016. RESULTS: Among 70,462 hospitalizations, 25 pediatric VTE cases were identified (3...
September 2016: Blood Research
Lucia Gerstl, Martin Olivieri, Florian Heinen, Ingo Borggraefe, Andreas Sebastian Schroeder, Moritz Tacke, Katharina Vill, Robert Dalla-Pozza, Karl Reiter, Juergen Lutz, Hartmut Brueckmann, Hendrik Janssen
BACKGROUND: Paediatric stroke is a potentially life-threatening emergency and requires immediate treatment to improve clinical outcome. In contrast to adult treatment recommendations, little is known about safety and efficacy of thrombolysis and mechanical thrombectomy in children. CASE DESCRIPTION AND CONCLUSION: We report on a three-year-old boy with a cardioembolic intracranial two-vessel occlusion and successful therapy with thrombolysis and mechanical thrombectomy...
November 2016: European Journal of Paediatric Neurology: EJPN
Martin Olivieri, Karin Kurnik, Florian Hoffmann, Karl Reiter, Christoph Bidlingmaier, Peter Kuhlencordt, Marcus Treitl
Descending iliofemoral thrombosis in children is a rare event. Anticoagulation therapy with low-molecular-weight-heparin is standard of care. However, patency cannot be achieved in all cases, increasing the risk for rethrombosis and postthrombotic syndrome. To reduce the risk of venous valve failure in adults, local catheter-directed thrombolysis is used to reopen vessels. Two adolescent girls (17 and 15 years old) presented with acute descending iliofemoral thrombosis of the left common iliac, external, and common femoral veins...
July 2016: Pediatrics
Gregory M Weiner, Rafey A Feroze, Nitin Agarwal, David M Panczykowski, William J Ares, Ali Kooshkabadi, Dana D Cummings, Vincent Carson, Amin Aghaebrahim, Brian T Jankowitz
BACKGROUND: Timely recognition of stroke at major pediatric medical centers is improving, and although treatment guidelines for pediatric stroke exist, no extensive study establishing the efficacy of surgical or thrombolytic treatment has been completed. Extrapolation of adult guidelines to pediatric patients remains the mainstay of treatment in the absence of adequate information regarding safety and efficacy in children. Recent trials have demonstrated revascularization and clinical improvement after endovascular retrieval therapy in adults with acute large vessel occlusive stroke...
August 2016: Pediatric Neurology
Jonathan Lena, Ramin Eskandari, Libby Infinger, Kyle M Fargen, Alejandro Spiotta, Aquilla Turk, Raymond D Turner, Imran Chaudry
Acute ischemic stroke (AIS) in the pediatric population is rare. Furthermore, it is common for physicians to take significantly longer diagnosing a posterior circulation stroke in a child than in an adult. There are increasing case reports in the literature of treating AIS in children with intravenous tissue plasminogen activator, intra-arterial thrombolysis, and/or mechanical thrombectomy. We present the first case of pediatric AIS treated using a direct aspiration first pass technique (ADAPT) as a means of mechanical thrombectomy...
April 13, 2016: Journal of Neurointerventional Surgery
Jonathan Lena, Ramin Eskandari, Libby Infinger, Kyle M Fargen, Alejandro Spiotta, Aquilla Turk, Raymond D Turner, Imran Chaudry
Acute ischemic stroke (AIS) in the pediatric population is rare. Furthermore, it is common for physicians to take significantly longer diagnosing a posterior circulation stroke in a child than in an adult. There are increasing case reports in the literature of treating AIS in children with intravenous tissue plasminogen activator, intra-arterial thrombolysis, and/or mechanical thrombectomy. We present the first case of pediatric AIS treated using a direct aspiration first pass technique (ADAPT) as a means of mechanical thrombectomy...
2016: BMJ Case Reports
Timothy J Bernard, Neil R Friedman, Nicholas V Stence, William Jones, Rebecca Ichord, Catherine Amlie-Lefond, Michael M Dowling, Michael J Rivkin
BACKGROUND: Childhood arterial ischemic stroke is an important cause of morbidity and mortality in children. Hyperacute treatment strategies remain controversial and challenging, especially in the setting of increasingly proven medical and endovascular options in adults. Although national and international pediatric guidelines have given initial direction about acute therapy and management, pediatric centers have traditionally lacked the infrastructure to triage, diagnose, and treat childhood arterial ischemic stroke quickly...
March 2016: Pediatric Neurology
Therese M Giglia, Char Witmer, David E Procaccini, Jonathan W Byrnes
OBJECTIVE: Thrombotic complications are increasingly being recognized as a significant cause of morbidity and mortality in pediatric and congenital heart disease. The objective of this article is to review the medications currently available to prevent and treat such complications. DATA SOURCES: Online searches were conducted using PubMed. STUDY SELECTION: Studies were selected for inclusion based on their scientific merit and applicability to the pediatric cardiac population...
March 2016: Pediatric Critical Care Medicine
Marian Gaballah, Junzi Shi, Kamlesh Kukreja, Leslie Raffini, Cristina Tarango, Marc Keller, Ganesh Krishnamurthy, John Racadio, Manish Patel, Anne Marie Cahill
PURPOSE: To evaluate technical feasibility, complications, and clinical outcomes of endovascular thrombolysis for iliofemoral thrombosis at two tertiary-care children's hospitals. MATERIALS AND METHODS: Institutional review board-approved retrospective review from March 2003 through June 2013 showed that venous thrombolysis for iliofemoral thrombosis was performed in 57 children (64 limbs) with a median age of 16.1 years (mean age, 14.5 y; range, 1.0-17.8 y). Techniques included catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and pharmacomechanical catheter-directed thrombolysis (PCDT) with adjunctive angioplasty and/or stent placement...
April 2016: Journal of Vascular and Interventional Radiology: JVIR
Anthony K Guzman, Mahmoud Zahra, Scott O Trerotola, Leslie J Raffini, Maxim Itkin, Marc S Keller, Anne Marie Cahill
BACKGROUND: Inferior vena cava (IVC) filters are commonly implanted with the intent to prevent life-threatening pulmonary embolism in at-risk patients with contraindications to anticoagulation. Various studies have reported increases in the rate of venous thromboembolism within the pediatric population. The utility and safety of IVC filters in children has not yet been fully defined. OBJECTIVE: To describe the technique and adjunctive maneuvers of IVC filter removal in children, demonstrate its technical success and identify complications...
April 2016: Pediatric Radiology
Olajide Williams, Ellyn Leighton-Herrmann, Alexandra DeSorbo, Mindy Hecht, Monique Hedmann, Saima Huq, William Gerin, Vernon Chinchilli, Gbenga Ogedegbe, James Noble
OBJECTIVE: Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke...
October 2015: Journal of Clinical Trials
Deidra A Ansah, Kavita N Patel, Leticia Montegna, George T Nicholson, Alexandra C Ehrlich, Christopher J Petit
OBJECTIVE: To review our institutional experience with tissue plasminogen activator (tPA) to determine outcomes related to bleeding complications and thrombus resolution. STUDY DESIGN: We performed a retrospective review of all patients who received systemic tPA for thrombolysis. Data points included location of thrombus, initial and maximum tPA dose, and duration of tPA. The primary endpoint was bleeding complication. RESULTS: Between 2005 and 2014, 46 patients received systemic tPA for thrombolysis: 17 (37%) were patients with a primary cardiac diagnosis, there were 17 (37%) hematology/oncology patients, and 12 (26%) patients with noncardiac, nonhematology/oncology diagnoses...
April 2016: Journal of Pediatrics
Vera Ignjatovic, Leonie Pelkmans, Hilde Kelchtermans, Raed Al Dieri, Coen Hemker, Romy Kremers, Saartje Bloemen, Vasiliki Karlaftis, Chantal Attard, Bas de Laat, Paul Monagle
INTRODUCTION: Infants and children have a lower incidence of thrombosis compared with adults. Yet, the mechanism of blood clot formation and structure in infants and children, as the end product of coagulation, has not been studied. This study aimed to establish differences in the mechanism of thrombin generation, fibrin clot formation and response to thrombolysis in infants and children compared with adults. MATERIALS AND METHODS: We studied thrombin generation, fibrin clot formation, structure and fibrinolysis in healthy infants, children and adults...
December 2015: Thrombosis Research
Yaser A Diab, Karthik Ramakrishnan, Fahad A Alfares, Conor F Hynes, Reginald Chounoune, Venkat Shankar, Joshua P Kanter, Dilip S Nath
BACKGROUND: Shunt or conduit thrombosis in a single ventricle circuit is a life-threatening complication that requires prompt treatment to rapidly restore shunt/conduit patency. Transcatheter interventions represent an attractive alternative to systemic thrombolysis or open surgical procedures. We report our center's experience with catheter-based approaches in patients with palliated single ventricle who present with shunt/conduit thrombosis. METHODS: A retrospective review was performed of all patients with palliated single ventricle physiology who were diagnosed over a 5-year period with shunt/conduit thrombosis and received catheter-based interventions...
January 2016: Congenital Heart Disease
Federica Viaro, Renzo Manara, Filippo Farina, Anna Palmieri, Foscarina D Rocca, Enzo Ballotta, Claudio Baracchini
INTRODUCTION: Current treatment guidelines for acute ischemic stroke do not recommend thrombolytic therapy in children and adolescents as data are still very scarce. CASE REPORT: We report the case of a 15-year-old boy who suddenly developed severe left-sided weakness and speech difficulty while stooling. Upon arrival at our Emergency Department, the National Institute of Health Stroke Scale (NIHSS) score was 18. Urgent neurovascular ultrasound showed a distal occlusion of the right internal carotid artery and occlusion at the origin of the middle cerebral artery (MCA) and the anterior cerebral artery...
September 2015: Neurologist
Vikram Kudumula, Demetris Taliotis, Christopher Duke
OBJECTIVE: The aim of this study was to assess the immediate and short-term results of transcatheter closure of patent ductus arteriosus (PDA) using the Occlutech duct occluder (ODO). BACKGROUND: The ODO is a new self-expanding nitinol device. Its body is wider at the pulmonary artery end than the aortic end. It is available in longer lengths than the Amplatzer duct occluder. METHODS: Twenty-two ODO implants were attempted in successive children referred for transcatheter device occlusion of PDAs ≥1 mm in diameter...
May 2015: Journal of Invasive Cardiology
Matthew P Lungren, Thomas J Ward, Manish N Patel, John M Racadio, Kamlesh Kukreja
Nine patients (average age 8.3 years, range 20 days to 17 years; average weight 31 kg, range 2.7-79 kg) with catheter-associated UE-DVT underwent upper extremity venous thrombolysis with the goal of access salvage. Catheter directed therapy with alteplase (tPA), balloon angioplasty, and mechanical thrombectomy was used in all cases. The mean total dose of TPA was 15 mg (range 1-40 mg). Venous access was ultimately preserved in all patients. No stents or superior vena cava filters were used. There was one episode of symptomatic clinically suspected pulmonary embolism managed by systemic tPA and heparin without long term sequaele...
October 2015: Journal of Thrombosis and Thrombolysis
Cameron C Trenor, Jeremy G Fisher, Faraz A Khan, Eric A Sparks, Juliann Duzan, Kathy Harney, Brian Dillon, Matthew Menard, Biren P Modi
OBJECTIVE: To review the presentation, management, and outcomes of Paget-Schroetter syndrome (PSS) in children and propose a multidisciplinary treatment algorithm involving pediatric and vascular surgery, interventional radiology, and hematology. STUDY DESIGN: Patients with PSS presenting between 2003 and 2013 were reviewed. Demographics, symptoms, therapies, and functional outcomes were noted. Data from early patients informed the development of a multidisciplinary treatment algorithm applied to later patients...
June 2015: Journal of Pediatrics
Maja Steinlin, Mark T Mackay
Children who present with acute neurological symptoms suggestive of a stroke need immediate clinical assessment and urgent neuroimaging to confirm diagnosis. Magnetic resonance imaging (MRI) is the investigation of first choice due to limited sensitivity of computed tomography (CT) for detection of ischaemia. Acute monitoring should include monitoring of blood pressure and body temperature, and neurological observations. Surveillance in a paediatric high dependency or intensive care unit and neurosurgical consultation are mandatory in children with large infarcts at risk of developing malignant oedema or haemorrhagic transformation...
May 2015: Current Treatment Options in Neurology
Spyridoula Tsetsou, Andrea O Rossetti, Patrick Michel, Lorenz Hirt, Christian Wider, David Benninger, Thierry Kuntzer, Bernard Nater, Jean-François Démonet, Myriam Schluep, Renaud A Du Pasquier, François Vingerhoets
In 2014, breastfeeding during maternal antiepileptic therapy seems to be safe for the children and can be recommended. Intravenous thrombolysis by Alteplase improves the outcome after a stroke if administered within 4.5 hours and it is also recommended in elderly population over 80 years. ProSavin genic therapy for Parkinson disease is under investigation. The Transcranial Magnetic Stimulation (TMS) has an analgesic effect in neuropathic pain as well as an antidepressant effect. Antagonists of calcitonin gene-related peptide can have a beneficial role in migraine prevention...
January 14, 2015: Revue Médicale Suisse
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