Pulmonary embolism and in situ pulmonary artery thrombosis in paediatrics

A systematic review

Madhvi Rajpurkar, Tina T. Biss, Ernest Amankwah, Denise Martinez, Suzan Williams, C. Heleen van Ommen, Neil Goldenberg

Research output: Contribution to journalReview article

Abstract

Data on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946-2013) and Embase (1980-2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51 % of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74 % of patients). The diagnosis of TE-PE was often delayed. Although 85 % of children with TE-PE had an elevated D-dimer at presentation, it was non-discriminatory for the diagnosis. In paediatric TE-PE, the prevalence of central venous catheters was 23 %, immobilisation 38 %, systemic infection 31 % and obesity 13 %, elevated Factor VIII or von Willebrand factor levels 27 %, Protein C deficiency 17 %, Factor V Leiden 14 % and Protein S deficiency 7 %. In patients with TEPE, pharmacologic thrombolysis was used in 29 %; unfractionated heparin was the most common initial anticoagulant treatment in 64 % and low-molecular-weight heparins the most common follow-up treatment in 83 %. Duration of anticoagulant therapy was variable and death was reported in 26 % of TE-PE patients. In contrast to TE-PE, patients with ISPAT were not investigated systematically for presence of thrombophilia, had more surgical interventions as the initial management and were often treated with anti-platelet medications. This review summarises important data and identifies gaps in the knowledge of paediatric PE, which may help to design future studies.

Original languageEnglish (US)
Pages (from-to)1199-1207
Number of pages9
JournalThrombosis and Haemostasis
Volume117
Issue number6
DOIs
StatePublished - Jan 1 2017

Fingerprint

Pulmonary Embolism
Pulmonary Artery
Thrombosis
Pediatrics
Anticoagulants
Protein S Deficiency
Protein C Deficiency
Thrombophilia
Central Venous Catheters
Low Molecular Weight Heparin
PubMed
Immobilization
Heparin
Therapeutics
Blood Platelets
Obesity
Infection

Keywords

  • Children
  • Paediatrics
  • Pulmonary artery thrombosis
  • Pulmonary embolism

ASJC Scopus subject areas

  • Hematology

Cite this

Pulmonary embolism and in situ pulmonary artery thrombosis in paediatrics : A systematic review. / Rajpurkar, Madhvi; Biss, Tina T.; Amankwah, Ernest; Martinez, Denise; Williams, Suzan; van Ommen, C. Heleen; Goldenberg, Neil.

In: Thrombosis and Haemostasis, Vol. 117, No. 6, 01.01.2017, p. 1199-1207.

Research output: Contribution to journalReview article

Rajpurkar, Madhvi ; Biss, Tina T. ; Amankwah, Ernest ; Martinez, Denise ; Williams, Suzan ; van Ommen, C. Heleen ; Goldenberg, Neil. / Pulmonary embolism and in situ pulmonary artery thrombosis in paediatrics : A systematic review. In: Thrombosis and Haemostasis. 2017 ; Vol. 117, No. 6. pp. 1199-1207.
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abstract = "Data on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946-2013) and Embase (1980-2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51 {\%} of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74 {\%} of patients). The diagnosis of TE-PE was often delayed. Although 85 {\%} of children with TE-PE had an elevated D-dimer at presentation, it was non-discriminatory for the diagnosis. In paediatric TE-PE, the prevalence of central venous catheters was 23 {\%}, immobilisation 38 {\%}, systemic infection 31 {\%} and obesity 13 {\%}, elevated Factor VIII or von Willebrand factor levels 27 {\%}, Protein C deficiency 17 {\%}, Factor V Leiden 14 {\%} and Protein S deficiency 7 {\%}. In patients with TEPE, pharmacologic thrombolysis was used in 29 {\%}; unfractionated heparin was the most common initial anticoagulant treatment in 64 {\%} and low-molecular-weight heparins the most common follow-up treatment in 83 {\%}. Duration of anticoagulant therapy was variable and death was reported in 26 {\%} of TE-PE patients. In contrast to TE-PE, patients with ISPAT were not investigated systematically for presence of thrombophilia, had more surgical interventions as the initial management and were often treated with anti-platelet medications. This review summarises important data and identifies gaps in the knowledge of paediatric PE, which may help to design future studies.",
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AU - Martinez, Denise

AU - Williams, Suzan

AU - van Ommen, C. Heleen

AU - Goldenberg, Neil

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AB - Data on paediatric pulmonary embolism (PE) are scarce. We sought to systematically review the current literature on childhood PE and conducted a search on paediatric PE via PubMed (1946-2013) and Embase (1980-2013). There was significant heterogeneity in reported data. Two patterns were noted: classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT). Mean age of presentation for TE-PE was 14.86 years, and 51 % of cases were males. The commonest method for diagnosis of TE-PE was contrast CT with angiography (74 % of patients). The diagnosis of TE-PE was often delayed. Although 85 % of children with TE-PE had an elevated D-dimer at presentation, it was non-discriminatory for the diagnosis. In paediatric TE-PE, the prevalence of central venous catheters was 23 %, immobilisation 38 %, systemic infection 31 % and obesity 13 %, elevated Factor VIII or von Willebrand factor levels 27 %, Protein C deficiency 17 %, Factor V Leiden 14 % and Protein S deficiency 7 %. In patients with TEPE, pharmacologic thrombolysis was used in 29 %; unfractionated heparin was the most common initial anticoagulant treatment in 64 % and low-molecular-weight heparins the most common follow-up treatment in 83 %. Duration of anticoagulant therapy was variable and death was reported in 26 % of TE-PE patients. In contrast to TE-PE, patients with ISPAT were not investigated systematically for presence of thrombophilia, had more surgical interventions as the initial management and were often treated with anti-platelet medications. This review summarises important data and identifies gaps in the knowledge of paediatric PE, which may help to design future studies.

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