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 Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland

nachricht Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke

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: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Northern oceans pumped CO2 into the atmosphere

27.03.2017 | Earth Sciences

Fingerprint' technique spots frog populations at risk from pollution

27.03.2017 | Life Sciences

Big data approach to predict protein structure

27.03.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>