Piovesan Dana, Attard Chantal, Monagle Paul, Ignjatovic Vera
Prof. Vera Ignjatovic, PhD, Haematology Research Laboratory, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia, Tel.: +61 3 99366520, E-mail:
Thromb Haemost. 2014 Jun;111(6):1015-21. doi: 10.1160/TH13-10-0827. Epub 2014 Feb 13.
There has been an extensive body of research focusing on the epidemiology of thrombosis in adult cancer populations; however, there is significantly less knowledge about thrombosis in paediatric cancer populations. Thrombosis is diagnosed with increasing frequency in children being treated for cancer, and there is an urgent need to increase our understanding of the epidemiology of thrombosis in this population. Currently, there are no guidelines for identification of high-risk groups, prophylaxis or management of thrombotic complications in paediatric cancer patients. We reviewed the available literature regarding the epidemiology, mechanisms, risk factors, prophylaxis and outcomes of thrombosis in children with cancer and identified areas that require further research. The reported incidence of symptomatic venous thromboembolism (VTE) in children with cancer ranges between 2.1% and 16%, while the incidence of asymptomatic events is approximately 40%. Approximately 30% of VTE in this population is associated with central venous lines (CVL). The most common location of VTE is upper and lower extremity deep venous thrombosis (43 to 50% of events, respectively), while 50% of events in ALL patients occur in the central nervous system. Key characteristics that increase the risk of thrombosis include the type of cancer, age of the patient, the presence of a CVL, presence of pulmonary/intra thoracic disease, as well as the type of chemotherapy. Outcomes for paediatric cancer patients with VTE include post-thrombotic syndrome, pulmonary embolism, recurrent thromboembolism, destruction of upper venous system and death. Prospective studies aimed at enabling risk stratification of patients are required to facilitate development of paediatric specific recommendations related to thromboprophylaxis in this population.
已有大量研究聚焦于成年癌症患者群体中的血栓形成流行病学；然而，对于儿科癌症患者群体中的血栓形成了解却少得多。在接受癌症治疗的儿童中，血栓形成的诊断频率日益增加，因此迫切需要加深我们对该群体血栓形成流行病学的理解。目前，尚无针对儿科癌症患者识别高危群体、预防或处理血栓形成并发症的指南。我们回顾了有关癌症患儿血栓形成的流行病学、机制、危险因素、预防措施及转归的现有文献，并确定了需要进一步研究的领域。据报道，癌症患儿有症状静脉血栓栓塞（VTE）的发生率在2.1%至16%之间，而无症状事件的发生率约为40%。该群体中约30%的VTE与中心静脉导管（CVL）相关。VTE最常见的部位是上肢和下肢深静脉血栓形成（分别占事件的43%至50%），而所有患者中50%的事件发生在中枢神经系统。增加血栓形成风险的关键特征包括癌症类型、患者年龄、CVL的存在、肺部/胸内疾病的存在以及化疗类型。患有VTE的儿科癌症患者的转归包括血栓形成后综合征、肺栓塞、复发性血栓栓塞、上静脉系统破坏和死亡。需要开展前瞻性研究以对患者进行风险分层，从而促进制定针对该群体儿科特异性血栓预防建议。
