title: Strategies to Prevent and Manage Thrombotic Complications of Acute Lymphoblastic Leukemia in Children and Young People Vary Between Centers in the United Kingdom.
abstract: There is a lack of evidence-based guidance for the prevention and management of thrombosis in children and young people treated for acute lymphoblastic leukemia. To determine current UK practice, a survey was sent to 28 centers participating in the Medical Research Council UKALL 2011 trial. Marked variation in practice was noted. In total, 43% of centers defer central venous access device insertion until end of induction for treatment of low-risk disease. Central venous access devices are removed at the end of intensive blocks in 38% and end of treatment in 42%. Duration of anticoagulation for line-associated thrombosis is 6 weeks in 43% and 3 months in 33% and for cerebral sinovenous thrombosis is 3 months in 71% and 6 months in 24%. Platelet transfusion to maintain platelet count >50×10/L, in preference to interrupting therapeutic anticoagulation, is used by 50% for line-associated thrombosis and 73% for cerebral sinovenous thrombosis. Conformity of practice was seen in some areas. In total, 70% treat thrombosis with twice-daily low-molecular weight heparin and 86% monitor antifactor Xa activity levels. In total, 91% reexpose individuals to asparaginase following a thrombotic event. Given this variation in practice, in the absence of high-quality evidence, consensus guidelines may be helpful.
authors.affiliation: *Department of Hematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne †Sheffield Children's Hospital, Sheffield ‡University College Hospital ¶Great Ormond Street Hospital, London §Royal Manchester Children's Hospital, Manchester ∥Royal Belfast Children's Hospital, Belfast #Royal Hospital for Children, Glasgow, UK.
authors.forename: Tina T
authors.initials: TT
authors.lastname: Biss
authors.forename: Jeanette H
authors.initials: JH
authors.lastname: Payne
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Hough
authors.forename: John D
authors.initials: JD
authors.lastname: Grainger
authors.forename: Christine
authors.initials: C
authors.lastname: Macartney
authors.forename: Keith R
authors.initials: KR
authors.lastname: Sibson
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chalmers
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000517:prevention & control*; D006113:United Kingdom; D055815:Young Adult