Betensky Marisol, Bittles Mark A, Colombani Paul, Goldenberg Neil A
Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Radiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Semin Intervent Radiol. 2017 Mar;34(1):35-49. doi: 10.1055/s-0036-1597762.
Over the past two decades, the incidence and recognition of venous thromboembolism (VTE) in children has significantly increased, likely as a result of improvements in the medical care of critically ill patients and increased awareness of thrombotic complications among medical providers. Current recommendations for the management of VTE in children are largely based on data from pediatric registries and observational studies, or extrapolated from adult data. The scarcity of high-quality evidence-based recommendations has resulted in marked variations in the management of pediatric VTE among providers. The purpose of this article is to summarize our institutional approach for the management of VTE in children based on available evidence, guidelines, and clinical practice considerations. Therapeutic strategies reviewed in this article include the use of conventional anticoagulants, parenteral targeted anticoagulants, new direct oral anticoagulants, thrombolysis, and mechanical approaches for the management of pediatric VTE.
在过去二十年中,儿童静脉血栓栓塞症(VTE)的发病率和诊断率显著上升,这可能是由于危重症患者医疗护理水平的提高以及医疗人员对血栓形成并发症的认识增强所致。目前关于儿童VTE管理的建议主要基于儿科登记处的数据和观察性研究,或从成人数据推断而来。高质量循证建议的匮乏导致医疗人员在儿童VTE管理方面存在显著差异。本文的目的是根据现有证据、指南和临床实践考量,总结我们机构对儿童VTE的管理方法。本文所综述的治疗策略包括使用传统抗凝剂、胃肠外靶向抗凝剂、新型直接口服抗凝剂、溶栓治疗以及儿童VTE管理的机械方法。