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Anticoagulant treatment for pediatric splanchnic vein thrombosis: a systematic review and meta-analysis
Omri Cohen1, Orly Efros2, Nicoletta Riva3
1National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Insights
Anticoagulant therapy for pediatric splanchnic vein thrombosis (SVT) shows moderate vessel recanalization rates and low bleeding risk. This treatment is associated with reduced mortality compared to no anticoagulation in children with SVT.
Area of Science:
- Pediatric Thrombosis Research
- Vascular Medicine
- Hematology
Background:
- Splanchnic vein thrombosis (SVT) in children presents unique clinical challenges.
- Optimal treatment strategies for pediatric SVT remain incompletely defined.
- This study addresses the knowledge gap regarding anticoagulant therapy effectiveness and safety in pediatric SVT.
Approach:
- Systematic review and meta-analysis of observational and interventional studies up to December 2021.
- Inclusion criteria: pediatric patients with SVT, reported anticoagulant treatment, and outcomes.
- Outcomes assessed: vessel recanalization, SVT extension, VTE recurrence, major bleeding, and mortality.
Key Points:
- 506 pediatric patients from 17 studies were analyzed, with portal vein thrombosis and Budd-Chiari syndrome being common.
- Anticoagulation was administered to 42.9% of patients, while 29.2% received vascular interventions.
- Pooled vessel recanalization rates were 55.3% with anticoagulation versus 29.4% without.
Conclusions:
- Anticoagulation in pediatric SVT is linked to moderate recanalization rates and a low incidence of major bleeding.
- Venous thromboembolism recurrence rates in anticoagulated pediatric SVT patients are low and comparable to other provoked VTE types.
- Anticoagulant therapy appears to be a safe and effective strategy, associated with significantly lower mortality rates.
Background:
The clinical characteristics of splanchnic vein thrombosis (SVT) in pediatric patients and its optimal treatment strategies are unknown.
Objectives:
This study aimed to assess the effectiveness and safety of anticoagulant therapy for pediatric SVT.
Methods:
MEDLINE and EMBASE databases were searched up to December 2021. We included observational and interventional studies that enrolled pediatric patients with SVT and reported anticoagulant treatment and outcomes, including rates of vessel recanalization, SVT extension, venous thromboembolism (VTE) recurrence, major bleeding, and mortality. Pooled proportions of vessel recanalization were calculated with their 95% CI.
Results:
A total of 506 pediatric patients (aged 0-18 years) across 17 observational studies were included. The majority of patients had portal vein thrombosis (n = 308, 60.8%) or Budd-Chiari syndrome (n = 175, 34.6%). Most events were triggered by transient provoking factors. Anticoagulation (heparins and vitamin K antagonists) was prescribed in 217 (42.9%) patients, and 148 (29.2%) patients underwent vascular interventions. The overall pooled proportions of vessel recanalization were 55.3% (95% CI, 34.1%-74.7%; I2 = 74.0%) among anticoagulated patients and 29.4% (95% CI, 2.6%-86.6%; I2 = 49.0%) among non-anticoagulated patients. SVT extension, major bleeding, VTE recurrence, and mortality rates were 8.9%, 3.8%, 3.5%, and 10.0%, respectively, in anticoagulated patients and 2.8%, 1.4%, 0%, and 50.3%, respectively, in non-anticoagulated patients.
Conclusion:
In pediatric SVT, anticoagulation appears to be associated with moderate recanalization rates and a low risk of major bleeding. VTE recurrence is low and comparable to that reported in pediatric patients with other types of provoked VTE.
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