title: Venous thromboembolism at uncommon sites in neonates and children.
abstract: We retrospectively analyzed the data of 24 children (whereof 11 neonates), with non-central venous line-related and nonmalignancy-related venous thromboembolism (VTE) at uncommon sites, referred to our Unit from January 1999 to January 2012. Thirty patients who also suffered deep vein thrombosis, but in upper/low extremities, were not included in the analysis. The location of rare site VTE was: portal (n=7), mesenteric (n=2) and left facial vein (n=1), spleen (n=3), lung (n=3), whereas 10 neonates developed renal venous thrombosis. The majority of patients (91.7%) had at least 1 risk factor for thrombosis. Identified thrombophilic factors were: antiphospholipid antibodies (n=2), FV Leiden heterozygosity (n=6), MTHFR C677T homozygosity (n=4), protein S deficiency (n=2), whereas all neonates had age-related low levels of protein C and protein S. All but 6 patients received low-molecular-weight heparin, followed by warfarin in 55% of cases, for 3 to 6 months. Prolonged anticoagulation was applied in selected cases. During a median follow-up period of 6 years, the clinical outcome was: full recovery in 15 patients, evolution to both chronic portal hypertension and esophageal varices in 2 children, and progression to renal failure in 7 of 10 neonates. Neonates are greatly vulnerable to complications after VTE at uncommon sites, particularly renal. Future multicentre long-term studies on neonatal and pediatric VTE at unusual sites are considered worthwhile.
authors: Haemostasis Unit, Haemophilia Centre, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors: Helen
authors: H
authors: Pergantou
authors: Maria
authors: M
authors: Avgeri
authors: Anna
authors: A
authors: Komitopoulou
authors: Panagiota
authors: P
authors: Xafaki
authors: Zoey
authors: Z
authors: Kapsimali
authors: Michail
authors: M
authors: Mazarakis
authors: Eftychia
authors: E
authors: Adamtziki
authors: Helen
authors: H
authors: Platokouki
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D004932:Esophageal and Gastric Varices / Q000473:pathology; D005165:Factor V / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008642:Mesenteric Veins / Q000473:pathology; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D011169:Portal Vein / Q000473:pathology; D018455:Protein S Deficiency / Q000473:pathology; D011667:Pulmonary Veins / Q000473:pathology; D012082:Renal Veins / Q000473:pathology; D012189:Retrospective Studies; D013154:Spleen / Q000473:pathology; D014680:Veins / Q000473:pathology*; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C095381:factor V Leiden; D014859:Warfarin; D005165:Factor V; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)