title: Assessment of the outcomes associated with periprocedural anticoagulation management in children with acute lymphoblastic leukemia.
abstract: OBJECTIVE
  To report the outcomes of an institutional protocol for periprocedural anticoagulant (AC) management in children with acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  Children being treated for ALL who received full-dose (therapeutic) anticoagulation before undergoing at least 1 lumbar puncture (LP) were included in this retrospective cohort study. The main outcome was the risk of traumatic LP; exploratory analysis included the risks of symptomatic spinal hematoma and progression/recurrence of the thrombotic event. Analyses were conducted using logistic regression analysis with a generalized estimating equation approach.
  
  
  RESULTS
  Twenty-two children with ALL receiving an AC underwent a total of 396 LPs. Although traumatic LP was associated with full-dose AC therapy in univariable analysis, a multiple logistic regression model controlling for other risk factors for traumatic LP showed that AC therapy was not significantly associated with the risk of traumatic LP when the ACs were held as per the institutional protocol. No patient developed symptomatic spinal hematoma. Exploratory analysis revealed that AC dose, a likely marker of thrombus burden, was significantly associated with progression/recurrence of the thrombotic event in univariable analysis.
  
  
  CONCLUSIONS
  In our cohort, recent AC therapy was not statistically associated with an increased risk of bleeding after LP when following a specific protocol for periprocedural AC management. The risk associated with the progression/recurrence of thromboembolic events requires further evaluation.
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Avila
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Macartney
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Johann K
authors.initials: JK
authors.lastname: Hitzler
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Suzan
authors.initials: S
authors.lastname: Williams
authors.affiliation: Department of Research Design and Biostatistics, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: leonardo.brandao@sickkids.ca.
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Brandão
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000139:chemically induced* / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000139:chemically induced* / Q000517:prevention & control; D013129:Spinal Puncture; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin