Anticoagulant treatment for pediatric splanchnic vein thrombosis: a systematic review and meta-analysis.
anticoagulants
hepatic vein
portal vein
splenic vein
venous thrombosis
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
18
01
2023
revised:
29
04
2023
accepted:
10
05
2023
medline:
21
8
2023
pubmed:
25
5
2023
entrez:
24
5
2023
Statut:
ppublish
Résumé
The clinical characteristics of splanchnic vein thrombosis (SVT) in pediatric patients and its optimal treatment strategies are unknown. This study aimed to assess the effectiveness and safety of anticoagulant therapy for pediatric SVT. MEDLINE and EMBASE databases were searched up to December 2021. We included observational and interventional studies that enrolled pediatric patients with SVT and reported anticoagulant treatment and outcomes, including rates of vessel recanalization, SVT extension, venous thromboembolism (VTE) recurrence, major bleeding, and mortality. Pooled proportions of vessel recanalization were calculated with their 95% CI. A total of 506 pediatric patients (aged 0-18 years) across 17 observational studies were included. The majority of patients had portal vein thrombosis (n = 308, 60.8%) or Budd-Chiari syndrome (n = 175, 34.6%). Most events were triggered by transient provoking factors. Anticoagulation (heparins and vitamin K antagonists) was prescribed in 217 (42.9%) patients, and 148 (29.2%) patients underwent vascular interventions. The overall pooled proportions of vessel recanalization were 55.3% (95% CI, 34.1%-74.7%; I In pediatric SVT, anticoagulation appears to be associated with moderate recanalization rates and a low risk of major bleeding. VTE recurrence is low and comparable to that reported in pediatric patients with other types of provoked VTE.
Sections du résumé
BACKGROUND
The clinical characteristics of splanchnic vein thrombosis (SVT) in pediatric patients and its optimal treatment strategies are unknown.
OBJECTIVES
This study aimed to assess the effectiveness and safety of anticoagulant therapy for pediatric SVT.
METHODS
MEDLINE and EMBASE databases were searched up to December 2021. We included observational and interventional studies that enrolled pediatric patients with SVT and reported anticoagulant treatment and outcomes, including rates of vessel recanalization, SVT extension, venous thromboembolism (VTE) recurrence, major bleeding, and mortality. Pooled proportions of vessel recanalization were calculated with their 95% CI.
RESULTS
A total of 506 pediatric patients (aged 0-18 years) across 17 observational studies were included. The majority of patients had portal vein thrombosis (n = 308, 60.8%) or Budd-Chiari syndrome (n = 175, 34.6%). Most events were triggered by transient provoking factors. Anticoagulation (heparins and vitamin K antagonists) was prescribed in 217 (42.9%) patients, and 148 (29.2%) patients underwent vascular interventions. The overall pooled proportions of vessel recanalization were 55.3% (95% CI, 34.1%-74.7%; I
CONCLUSION
In pediatric SVT, anticoagulation appears to be associated with moderate recanalization rates and a low risk of major bleeding. VTE recurrence is low and comparable to that reported in pediatric patients with other types of provoked VTE.
Identifiants
pubmed: 37225019
pii: S1538-7836(23)00427-0
doi: 10.1016/j.jtha.2023.05.014
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2499-2508Informations de copyright
Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interests O.C. reports IIS grants from Pfizer and personal fees from PlasFree, outside the submitted work. S.L.-M. reports grants from Pfizer and Novonordisk and personal fees from Pfizer, outside the submitted work. W.A. reports grants and personal fees from Bayer and personal fees from BMS/Pfizer, Sanofi, Viatris, and Norgine, outside the submitted work. G.K. reports grants from Pfizer and Roche; other receipts from ASC therapeutics, Bayer, Novonordisk, Pfizer, Roche, and Sanofi-Genzyme; and personal fees from Bayer, BioMarine, BPL, CSL, Pfizer, Novonordisk, Roche, Sanofi-Genzyme, Sobi, Spark, Takeda, and Uniquore, outside the submitted work. All other authors have no competing interests to disclose.