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Assessment of the outcomes associated with periprocedural anticoagulation management in children with acute

Maria L Avila1, Christine A Macartney1, Johann K Hitzler1

  • 1Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

The Journal of Pediatrics
|March 4, 2014
PubMed

Insights

Children with acute lymphoblastic leukemia (ALL) on anticoagulation (AC) can safely undergo lumbar puncture (LP) when following a specific protocol. This study found no increased bleeding risk from AC during LP in pediatric ALL patients.

Area of Science:

  • Pediatric Hematology
  • Oncology
  • Clinical Thrombosis

Background:

  • Management of anticoagulation (AC) in pediatric patients with acute lymphoblastic leukemia (ALL) undergoing procedures like lumbar puncture (LP) presents a clinical challenge.
  • Balancing the risk of bleeding from AC against the risk of thrombotic events is critical in this population.

Purpose of the Study:

  • To evaluate the safety and outcomes of an institutional protocol for periprocedural anticoagulant management in children with ALL undergoing LP.
  • To assess the risk of traumatic LP, spinal hematoma, and thrombotic event recurrence in this cohort.

Main Methods:

  • Retrospective cohort study of children with ALL receiving therapeutic anticoagulation prior to at least one LP.
  • Logistic regression analysis with generalized estimating equations was used to determine the risk of traumatic LP.
  • Exploratory analysis included symptomatic spinal hematoma and thrombotic event progression/recurrence.

Main Results:

  • Thirty-nine LPs were performed on 22 children with ALL on AC.
  • While univariable analysis suggested an association between AC and traumatic LP, multivariable analysis controlling for other risk factors found no significant link when AC was managed per protocol.
  • No symptomatic spinal hematomas occurred; however, AC dose, a marker of thrombus burden, was associated with thrombotic event progression/recurrence in univariable analysis.

Conclusions:

  • Adherence to the institutional protocol for periprocedural AC management in pediatric ALL patients undergoing LP was not associated with an increased risk of bleeding.
  • Further investigation is warranted to understand the risks associated with the progression or recurrence of thromboembolic events in this patient group.
Abstract

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