Arterial thromboembolic disease: a single-centre case series study.
OBJECTIVE
Paediatric venous thromboembolic disease has been reported with increased frequency during the last decade. In contrast, the pathophysiology of arterial thromboembolic disease in infants and children has not been adequately explored. The aim of this study was to determine the prevalence, aetiology, diagnostic criteria, management and outcome of arterial thromboembolism (TE) in a tertiary paediatric centre.


METHODS
A prospective, single-centre registry was established at an Australian tertiary paediatric centre in order to address the aim of this study.


RESULTS
One-hundred-and-two arterial thrombotic events occurred in 98 patients during 48 months. Infants were most likely to have a lower limb arterial TE (n = 22) whilst children were most likely to have a central nervous system arterial TE (n = 26). Surgery was a frequent predisposing factor in both infants and children. Doppler ultrasonography, computerized tomography and magnetic resonance imaging were the most commonly used diagnostic modalities. Unfractionated heparin was the most frequently used treatment in both age groups. At discharge, 25 infants and twelve children had complete resolution of their arterial TE. Direct thrombosis-related mortality was 4% in infants and 9% in children. Duration of follow-up ranged from 1 to 900 days, with thirteen infants and 32 children never achieving complete resolution. Forty-nine percent of post-discharge survivors had significant long term sequelae directly attributable to their arterial TE.


CONCLUSIONS
Arterial TE occurred as frequently as venous TE in our tertiary paediatric population. The clinical outcome and long term sequelae of such events are significant.
Monagle
Paul
P
Department of Clinical Haematology, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Newall
Fiona
F
Barnes
Chris
C
Savoia
Helen
H
Campbell
Janine
J
Wallace
Timothy
T
Crock
Catherine
C
D000293:Adolescent; D017677:Age Distribution; D000925:Anticoagulants / Q000627:therapeutic use; D001158:Arteries; D015984:Causality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology