The evaluation and management of postnatal thromboses.
In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed.
Saxonhouse
M A
MA
Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32610, USA. saxonma@peds.ufl.edu
Burchfield
D J
DJ
D000925:Anticoagulants / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants; D005343:Fibrinolytic Agents