Thrombotic complications in children with cancer.
The last decade has seen advances in treatment of life-threatening disease in children--especially cancer where the overall cure rate is now in the region of 80%. Similar to adults, children with cancer are at a substantial risk of developing thromboembolism (TE). One of the costs of achieving this has been more children developing thrombotic disease, the majority of which are related to indwelling vascular catheters and as a resultTE is being diagnosed with increasing frequency in these younger patients. In the Canadian Paediatric Thrombophilia Registry, 20% of the patients with TE had cancer. This figure is in contrast to only 2.3 cases of malignancy/1000 children and an estimated incidence of thrombosis of 0.7/100,000 in the general paediatric population. However, the true prevalence of TE in children with cancer is unknown as rates can vary from 1% to as high as 44% [5] and this reflects the heterogeneity of such studies in terms of; (i) type of cancer, (ii) was the TE, symptomatic or asymptomatic and (iii) were the studies prospective or retrospective. Happening alongside these advances have been an explosion in our knowledge of the understanding at the molecular level of blood coagulation in particular how the natural anticoagulant and fibrinolytic pathways work and how they differ in children and adults. Stemming from these discoveries new anticoagulant therapeutics have become available to the paediatrian and over the next decade their true place in the treatment of childhood thrombotic disease will be established.
Smith
O P
OP
Dublin University, Trinity College Dublin and Our Lady's Children's Hospital, Crumlin Dublin 12, Ireland. owen.smith@olchc.ie
D002648:Child; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control