Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study sheds light on risk of life-threatening blood clots in hospitalized children

12.12.2013
Life-threatening blood clots occur so rarely in children that the condition, known as venous thromboembolism (VTE), is often not on pediatricians' mental radar screens — an absence that can lead to woefully delayed recognition and treatment.

Now findings of a Johns Hopkins Children's Center study, published online Dec. 12 in The Journal of Pediatrics, may help clinicians determine which hospitalized children are at greatest risk of VTE and require vigilant monitoring or preemptive treatment with anticlotting medications.

The investigators say that in the absence of much-needed pediatric guidelines on VTE prophylaxis in children, the study findings can help guide clinical decision-making for certain categories of hospitalized patients who are at a disproportionately high risk for developing clots.

Such categories include older teens and young adults, those with multiple medical conditions, patients with central venous catheters and those with cardiac and renal disease.

The study, which analyzed 15 years' worth of medical records of thousands of children treated at the Johns Hopkins Children's Center between 1994 and 2009, found 270 cases of VTE in more than 90,000 pediatric admissions. Despite the miniscule overall VTE rate, clotting risk loomed large in several groups, with older age and the presence of multiple medical conditions carrying the highest risk of VTE.

Young adults between the ages of 18 and 21 were eight times more likely to develop a clot than younger children between the ages of 2 and 9. Teens, ages 14 to 17, had a four-fold rate of VTEs, compared with younger children. In addition, teenage girls and young women were nearly two times as likely to develop a clot as males the same age. Children with four or more medical conditions were four times more likely to develop VTE than others.

Other factors that appeared to fuel clotting risk were the presence of central venous catheters, recent surgery and traumatic injuries. Half of the 238 children who developed clots had a central venous catheter, and 40 percent of clots developed in children who'd undergone recent surgeries. When clots developed in infants, they did so predominantly in patients with congenital heart defects. By contrast, clots in trauma patients tended to develop mostly in older teens and young adults.

The research team says that children who fall into more than one category should be monitored extra vigilantly for signs suggestive of a clot.

"Are we saying that every kid with more than one risk factor should be on prophylactic treatment? Absolutely not," says study lead investigator Cliff Takemoto, M.D., a pediatric hematologist at the Johns Hopkins Children's Center. "What we are saying, however, is that we, as clinicians, should take a closer look at each and every patient with multiple risk factors and gauge cumulative risk — if the chance of clotting appears high enough, then treatment is certainly reasonable."

Considered somewhat of a clinical enigma in children, VTEs have been long recognized as a major threat in hospitalized and immobilized adults. This well-established risk is at the heart of guidelines that call for preventive anticlotting therapy in adults with certain conditions. But because clotting risk in children is so poorly understood, the researchers say, pediatricians often find themselves at a loss when trying to decide whom to treat and when. In addition, because anticlotting medications can cause harmful side effects including excess bleeding and low platelet counts physicians are understandably hesitant to use them preemptively in children.

"Blood clots in children are quite rare, yet when they do occur they can be life-threatening, so treatment decisions often pose an intricate dilemma for clinicians who have to weigh the small risk of a potentially fatal condition against the possibility of serious harm that can come from prophylactic treatment," Takemoto says.

Findings of the new study add to a growing body of research on clotting risk in children. Another recent Johns Hopkins study, published Oct. 30 in JAMA Surgery, found that VTE risk among children with traumatic injuries rose dramatically in those 16 and older. Patients in that age group were nearly four times more likely to develop life-threatening blood clots than their younger counterparts.

Usually arising in the veins of the legs, blood clots can break away and travel to the lungs where they lodge in the arteries, obstruct breathing and cause a potentially fatal condition known as pulmonary embolism. Signs of deep vein clots include pain, tenderness and swelling at the site of clot formation, usually in the legs or arms. Symptoms suggestive of pulmonary embolism include chest pain, rapid and labored breathing, spitting blood and fainting.

Other investigators involved in research were Sajeet Sohi, M.D.; Kruti Desai, M.D.; Raman Bharaj, M.D.; Anuj Khanna, M.D.; Susan McFarland, M.D.; Sybil Klaus, M.D.; Alia Irshand, M.D.; Neil Goldenberg, M.D., Ph.D.; J.J. Strouse, M.D., Ph.D.; and Michael Streiff, M.D.; all of Johns Hopkins.

Related on the Web:

Study: Anti-Clotting Drugs Rarely Needed in Children with Big-Bone Fractures
http://www.hopkinschildrens.org/Study-Anti-Clotting-Drugs-Rarely-Needed-in-Children-with-Big-Bone-Fractures.aspx

JAMA Surgery: Venous Thromboembolism after Trauma: When Do Children Become Adults?

http://archsurg.jamanetwork.com/article.aspx?articleid=1764700&resultClick=1

Ekaterina Pesheva | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Studies and Analyses:

nachricht Real-time feedback helps save energy and water
08.02.2017 | Otto-Friedrich-Universität Bamberg

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Impacts of mass coral die-off on Indian Ocean reefs revealed

21.02.2017 | Earth Sciences

Novel breast tomosynthesis technique reduces screening recall rate

21.02.2017 | Medical Engineering

Use your Voice – and Smart Homes will “LISTEN”

21.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>