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A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
How I treat pediatric pulmonary embolism
Ayesha Zia1, Neil A Goldenberg2,3, Madhvi Rajpurkar4,5
1Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Pediatric pulmonary embolism (PE) is rising, particularly in adolescents. Advances in risk prediction, anticoagulation trials, and understanding long-term effects are improving management, though questions remain.
Area of Science:
- Pediatric Hematology
- Cardiovascular Medicine
- Clinical Research
Background:
- Venous thromboembolism (VTE) affects 1 in 200 hospitalized children.
- Diagnoses of pulmonary embolism (PE), a severe VTE form, have increased by 200% in two decades, especially in adolescents.
- Pediatric PE management is highly variable, necessitating updated clinical guidelines.
Purpose of the Study:
- To review recent advances in pediatric PE management and research over the past decade.
- To highlight shifts in clinical practice, including PE Response Teams and multidisciplinary decision-making.
- To discuss progress in anticoagulation therapy, post-PE syndrome understanding, and future research needs.
Main Methods:
- Review of published studies on pediatric PE within the last 10 years.
- Analysis of clinical trials on anticoagulation in children and adolescents.
- Examination of research on post-PE syndrome and management strategies.
Main Results:
- Implementation of pediatric PE Response Teams and multidisciplinary approaches for severe cases.
- Completion of clinical trials for pediatric anticoagulation and ongoing research into optimal therapy duration.
- Advancements in understanding and evaluating post-PE syndrome.
Conclusions:
- Significant progress has been made in pediatric PE diagnosis and management.
- Continued research is crucial to address remaining questions and refine treatment protocols.
- Multidisciplinary care and evidence-based guidelines are essential for improving outcomes in pediatric PE.
Abstract:
Venous thromboembolism (VTE) affects ∼1 in 200 hospitalized children. The diagnosis of pulmonary embolism (PE), the most severe clinical presentation of VTE, has increased dramatically by ∼200% over the past 2 decades, disproportionately affecting adolescents, and is associated with adverse long-term post-PE sequelae. Nevertheless, the management of pediatric PE remains highly variable. This review focuses on significant advances in pediatric PE, with a focus on published studies within the past decade. Using a representative case, we: (1) summarize existing risk prediction tools for acute pediatric PE, and a shift in clinical practice in the management of acute PE with the implementation of pediatric PE response teams and multidisciplinary decision-making for severe pediatric PE, (2) describe recently completed clinical trials of anticoagulation in children and adolescents, and ongoing work to elucidate the appropriate duration of therapy for children and adolescents with PE, and (3) review advances in understanding post-PE syndrome, and the need for continued refinement of evaluation tools and management approaches. Many unanswered questions remain despite the significant advances in pediatric thrombosis over the past decade.
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