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Thromboembolic complications in Thai pediatric patients
A Chuansumrit1, S Chiemchanya, P Khowsathit
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Pediatric thromboembolic complications often stem from underlying conditions and deficiencies in natural anticoagulants like antithrombin III, protein C, or protein S. Comprehensive investigation and tailored treatment are crucial to prevent recurrent events in children.
Area of Science:
- Pediatric Hematology
- Thromboembolic Disorders
- Clinical Pediatrics
Background:
- Thromboembolic complications present a significant challenge in pediatric care.
- Retrospective analysis of pediatric cases from 1987-1997 at Ramathibodi Hospital.
Purpose of the Study:
- To investigate the characteristics, management, and outcomes of thromboembolic complications in pediatric patients.
- To emphasize the importance of comprehensive evaluation and specific treatment to prevent recurrence.
Main Methods:
- Retrospective study of 60 pediatric patients with thromboembolic events.
- Analysis of patient demographics, affected sites, triggering conditions, underlying diseases, and laboratory findings (antithrombin III, protein C, protein S levels).
- Review of management strategies and patient outcomes, including fatality rates and recurrent episodes.
Main Results:
- Thromboembolic events occurred in various sites, including the central nervous system (27.5%), skin (24.5%), and limbs/colon (19%).
- Most patients (80%) had triggering conditions and (76.7%) underlying diseases; 42% showed deficiencies in antithrombin III, protein C, or protein S.
- The fatality rate was 15%, with recurrence in 6 patients, often linked to non-adherence to treatment or underlying conditions like vasculitis.
Conclusions:
- Pediatric thromboembolism is frequently associated with identifiable risk factors and coagulopathies.
- Effective management requires addressing underlying causes and implementing specific anticoagulant therapies.
- Thorough investigation and personalized treatment are essential for improving outcomes and preventing recurrent thromboembolic events in children.
Abstract:
Sixty patients with thromboembolic complications from 1987 to 1997 at the Department of Pediatrics, Ramathibodi Hospital were retrospectively studied. Twenty patients were infants and 40 patients were children and adolescents with a mean age of 18 days and 8 years, respectively. The sites of thromboembolic complications were in the central nervous system, 27.5 per cent; skin as purpura fulminans or necrotic lesions, 24.5 per cent; gangrene of the toe, finger or colon, 19 per cent; deep vein thrombosis, 16 per cent; and other sites such as heart and lungs, 13 per cent. Most of them had triggering conditions (80%) and underlying diseases (76.7%) causing thromboembolism. The low levels of either antithrombin III, protein C or protein S were found in 42 per cent (15/36). The management included administration of standard or low molecular weight heparin if not contraindicated, replacement of fresh frozen plasma 10 ml/kg twice a day and treatment of underlying and triggering conditions. The fatality rate was 15 per cent (9/60). Subsequent episodes of thromboembolism occurred in 6 patients including: pulmonary emboli in one patient with protein C deficiency who refused warfarin administration, deep vein thrombosis in 2 patients with unidentified etiology, and necrotic skin lesions in 3 patients with vasculitis who did not respond to treatment. In conclusion, a comprehensive investigation and specific treatment for patients with thromboembolic complications are emphasized in order to prevent recurring episodes.
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