Agarwal Shreya, Mullikin Dolores, Scheurer Michael E, Smith Valeria, Naik-Mathuria Bindi, Guillerman R Paul, Foster Jennifer H, Diaz Rosa, Sartain Sarah E
Texas Children's Hospital, Cancer and Hematology Center, Baylor College of Medicine, Houston, Texas, USA.
Center for Epidemiology and Population Health, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Pediatr Blood Cancer. 2021 Sep;68(9):e29173. doi: 10.1002/pbc.29173. Epub 2021 Jun 1.
Children with cancer diagnosis are overall at a higher risk of thrombosis. For a newly diagnosed blood clot, patients are commonly started on anticoagulants to prevent further extension and embolization of the clot. In the rare instance that a pediatric patient has a tumor thrombus, role of anticoagulation is less clear.
PROCEDURE/METHODS: Patients under 21 years of age with a finding of tumor thrombus on imaging from 2010 to 2020 at Texas Children's Hospital were identified and their medical records were reviewed.
A total of 50 patients were identified. Most thrombi were incidental findings at diagnosis; however, two patients presented with pulmonary embolism (PE). Inferior vena cava extension was noted in 36% of the patients, and 24% patients had an intracardiac tumor thrombus. Anticoagulation was initiated in 10 patients (20%). There was no difference in the rate of bland thrombus formation and/or embolization in patients who did or did not receive anticoagulation. However, three of the six patients with asymptomatic tumor thrombus who were started on anticoagulation had bleeding complications compared to only two patients in the no anticoagulation cohort (p < .05).
Children with intravascular extension of solid tumors were not commonly started on anticoagulation at the time of diagnosis, irrespective of the extent of tumor thrombus. Furthermore, we observed a significant trend toward higher incidence of bleeding complications after initiation of anticoagulation for asymptomatic tumor thrombus. There is inadequate evidence at this time to support routine initiation of anticoagulation in pediatric patients with intravascular extension of solid tumors.
癌症确诊儿童总体上发生血栓形成的风险更高。对于新诊断出的血栓，患者通常开始使用抗凝剂以防止血栓进一步扩展和栓塞。在儿科患者出现肿瘤血栓这种罕见情况下，抗凝的作用尚不太明确。
程序/方法：确定了2010年至2020年在德克萨斯儿童医院影像学检查发现有肿瘤血栓的21岁以下患者，并对其病历进行了审查。
共确定了50例患者。大多数血栓是在诊断时偶然发现的；然而，有两名患者出现了肺栓塞（PE）。36%的患者下腔静脉有血栓延伸，24%的患者有心内肿瘤血栓。10例患者（20%）开始接受抗凝治疗。接受或未接受抗凝治疗的患者在单纯血栓形成和/或栓塞发生率方面没有差异。然而，开始接受抗凝治疗的6例无症状肿瘤血栓患者中有3例出现了出血并发症，而未接受抗凝治疗的队列中只有2例出现出血并发症（p <.05）。
实体瘤血管内有血栓延伸的儿童在诊断时通常不开始抗凝治疗，无论肿瘤血栓的范围如何。此外，我们观察到，对于无症状肿瘤血栓，开始抗凝治疗后出血并发症的发生率有显著升高趋势。目前没有足够的证据支持对实体瘤血管内有血栓延伸的儿科患者常规开始抗凝治疗。
