Molinari Angelo C, Saracco Paola, Cecinati Valerio, Miano Maurizio, Parodi Emilia, Grassi Massimo, Banov Laura, De Mattia Domenico, Giordano Paola
Dipartimento di Emato Oncologia, Istituto Giannina Gaslini, Genoa, Italy.
Blood Coagul Fibrinolysis. 2011 Jul;22(5):351-61. doi: 10.1097/MBC.0b013e3283424824.
More and more cases of venous thrombosis are diagnosed in children thanks to newer imaging modalities. Central venous catheters have become commonplace in the care of critically ill children and have contributed to the increased rate of thrombotic events. Lastly, children who develop life-threatening or chronic medical conditions are surviving longer because of advanced medical therapies; these intensive therapies can be complicated by events such as thrombosis. Over the last 10 years, specific guidelines for treating thrombosis in children have become available. Nevertheless, in many situations anticoagulant treatment is specially tailored to each individual patient's needs. Some new antithrombotic drugs which have undergone clinical testing in adults might be beneficial to paediatric patients with thromboembolic disorders; unfortunately, clinical data and reports on the use of these drugs in children, when available, are extremely limited. The aim of this review is to provide physicians with enough background information to be able to manage thrombosis in children. First, by helping them detect a thrombotic event in a child. Upon confirmation of the diagnosis, the physician will request the appropriate tests and will choose the best treatment on the basis of the guidelines and recommendations. Moreover, the paediatrician will have the information he or she needs to identify which children are at highest risk of acute thrombotic events and relevant long-term sequelae and, therefore, to decide on the appropriate prophylactic or pharmacologic strategy. Lastly, we would like to provide the paediatrician with information on future drugs with regard to the treatment and prophylaxis of thrombosis.
由于采用了更新的成像方式，儿童静脉血栓形成的诊断病例越来越多。中心静脉导管在危重症儿童护理中已变得很常见，并且导致血栓形成事件的发生率增加。最后，患有危及生命或慢性疾病的儿童因先进的医疗疗法存活时间更长；这些强化治疗可能会因血栓形成等事件而变得复杂。在过去10年中，已经有了针对儿童血栓形成治疗的具体指南。然而，在许多情况下，抗凝治疗是根据每个患者的具体需求专门定制的。一些在成人中进行过临床试验的新型抗血栓药物可能对患有血栓栓塞性疾病的儿科患者有益；不幸的是，关于这些药物在儿童中使用的临床数据和报告（如果有的话）极其有限。本综述的目的是为医生提供足够的背景信息，以便能够处理儿童血栓形成问题。首先，帮助他们在儿童中检测到血栓形成事件。确诊后，医生将要求进行适当的检查，并根据指南和建议选择最佳治疗方法。此外，儿科医生将获得他或她所需的信息，以确定哪些儿童发生急性血栓形成事件和相关长期后遗症的风险最高，从而决定适当的预防或药物治疗策略。最后，我们希望为儿科医生提供有关未来用于血栓形成治疗和预防的药物的信息。
