Samji Nasrin, Bhatt Mihir D, Kulkarni Ketan
Department of Pediatrics, Division of Hematology Oncology, McMaster University, Hamilton, ON, Canada.
Department of Pediatrics, Division of Hematology Oncology, Dalhousie University and Izaak Walton Killam (IWK) Health Centre, Halifax, NS, Canada.
Front Pediatr. 2022 Apr 7;10:855162. doi: 10.3389/fped.2022.855162. eCollection 2022.
Venous thromboembolism (VTE) occurs in 2.1 to up to 50% of children with cancer and contributes to long term morbidity as well as early mortality in this population. Pediatric patients with malignancy are predisposed to VTE due to the prothrombotic nature of cancer and its associated coagulopathies as well as chemotherapeutic agents, use of central venous catheters, surgery, radiotherapy, and concomitant thrombophilia. Management of thrombosis in this population is challenging due to concomitant thrombocytopenia, associated bleeding risks, concurrent co-morbidities, and toxicities of therapy. The aim of this paper is to highlight clinically relevant issues and management dilemmas using clinical vignettes. We review the clinical significance of asymptomatic and symptomatic thrombosis, examine the various options for asparaginase-associated thrombosis, address the role and controversies of direct oral anticoagulants, and describe our approach to managing anticoagulation therapy in the context of chemotherapy-induced thrombocytopenia.
静脉血栓栓塞症（VTE）在2.1%至高达50%的癌症患儿中发生，是导致该人群长期发病以及早期死亡的原因。患有恶性肿瘤的儿科患者由于癌症的促血栓形成特性及其相关凝血病、化疗药物、中心静脉导管的使用、手术、放疗以及合并存在的血栓形成倾向而易于发生VTE。由于合并血小板减少症、相关出血风险、并发的共病以及治疗毒性，对该人群血栓形成的管理具有挑战性。本文旨在通过临床案例突出临床相关问题和管理困境。我们回顾无症状和有症状血栓形成的临床意义，研究天冬酰胺酶相关血栓形成的各种选择，探讨直接口服抗凝剂的作用及争议，并描述我们在化疗诱导的血小板减少症背景下管理抗凝治疗的方法。
