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Abbinanti A, Witt DM, Saunders J, Jones AE, Young DC. Venous thromboembolism management in people with cystic fibrosis. Pediatr Pulmonol 2024; 59:584-591. [PMID: 38038058 DOI: 10.1002/ppul.26786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Rates of venous thromboembolism (VTE) are increasing in people with cystic fibrosis (PwCF). Providers treating VTE in PwCF have reported low confidence concerning anticoagulant drug selection, dose, duration, and drug-drug interactions. As there are currently no published reports regarding management of VTE in PwCF, our objective was to describe the management of VTE in PwCF. METHODS PwCF and VTE at the University of Utah Health were identified through electronic medical record searches. Patients were categorized into one of three treatment groups: warfarin, direct oral anticoagulant (DOAC), and low molecular weight heparin (LMWH). The primary outcome was episodes of major bleeding. Secondary outcomes included clinically relevant nonmajor (CRNM) bleeding. RESULTS Nine PwCF with a total of 12 unique VTE episodes were included in the study, with all but one episode associated with a peripherally inserted central catheter (PICC). Of the 12 VTE cases, 25% were treated with warfarin, 50% with a DOAC, and 25% with LMWH. There were no episodes of major bleeding and only one episode of CRNM bleeding (Hemoptysis) in the LMWH group. All anticoagulant doses and durations generally followed guidelines for persons without CF. DOACs were the most common VTE treatment, at doses and duration consistent with guidelines for persons without CF, with no major or CRNM bleeding. CONCLUSION VTE treatment in PwCF is generally consistent with guidelines for persons without CF with low rates of bleeding. DOACs are a potential option for treatment of VTE in PwCF, but more research is needed.
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Affiliation(s)
- Alan Abbinanti
- Department of Pharmacy, Huntsman Mental Health Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Witt
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - John Saunders
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Aubrey E Jones
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - David C Young
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
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Ergenekon AP, Yilmaz Yegit C, Cenk M, Gulieva A, Kalyoncu M, Selcuk M, Dogru O, Erdem Eralp E, Gokdemir Y, Karakoc F, Karadag B. The utility of risk assessment tools for acute pulmonary embolism in children. Pediatr Pulmonol 2023; 58:55-60. [PMID: 36121121 DOI: 10.1002/ppul.26155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
UNLABELLED BACKGROUND AND AIM: Pulmonary embolism (PE) is a potentially life-threatening disease in children. The objective of the study is to evaluate the utility of adult-based pulmonary embolism rule-out criteria (PERC), Pediatric PE Model, and D-dimer in the diagnosis of PE in children. MATERIAL AND METHODS The study consisted of patients under 18 years of age who were consulted to the Pediatric Pulmonology Clinic for the evaluation of PE. Patients were divided into two groups based on the confirmation of PE. The group with the presence of PE (n = 20) consisted of children who were diagnosed with PE. The group with the absence of PE (n = 28) consisted of children with clinically suspected PE but negative diagnostic imaging. Adult validated clinical decision PERC rule and Pediatric PE Model were retrospectively applied to the patients. RESULTS In the study, PERC demonstrated a sensitivity of 60% and a specificity of 46% for the diagnosis of PE in children. When PE Model was evaluated for the children, it was found a 50% sensitivity and 75% specificity. Combining PE Model and PERC rule with D-dimer did not increase the specificity and sensitivity. Smoking was found to be relevant for PE in the childhood. Twenty-five percent of the patients had a genetic tendency for PE. All of the patients had an underlying disease as well. CONCLUSION None of the current risk assessment tools (PE Model, PERC, D-dimer) were found to be accurate in predicting PE. Further larger population studies are still required to develop a better diagnostic approach.
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Affiliation(s)
- Almala P Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Merve Selcuk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Omer Dogru
- Division of Pediatric Hematology and Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Mahan KS, Ahmad H, Keenan AG, Prekker ME, Kempainen RR. Yield of chest computed tomography angiogram in cystic fibrosis patients with suspected pulmonary embolism. Clinical Respiratory J 2022; 16:226-233. [PMID: 35060348 PMCID: PMC9060046 DOI: 10.1111/crj.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 08/14/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
Introduction Individuals with cystic fibrosis (CF) may be at increased risk of pulmonary embolism (PE). Symptoms of PE overlap substantially with those of CF respiratory exacerbations. CF patients commonly undergo chest computed tomography (CT) angiograms (CTPA) to evaluate for PE, but little is known about the clinical presentation and diagnosis of PE in this population. Objectives The objectives of this study are to determine the diagnostic yield of CTPA for PE in adult patients with CF and assess the utility of the Revised Geneva Score (RGS) in this population. Methods Retrospective review of all CTPA results was performed on CF patients with suspected PE at a large CF center from 1 January 2011 through 31 March 2017. Patient demographics, medical history, and presenting signs and symptoms were abstracted by chart review. Results A total of 103 unique CTPA studies were performed in 68 patients. Most were hospitalized at the time of CTPA, predominantly for respiratory manifestations of CF. CTPA identified four patients with PE. The small number of positive studies precluded analysis of predictors of PE. Fewer PE were diagnosed than predicted by the Revised Geneva Score, which was intermediate probability in 77/103 (75%) patients. Conclusion The prevalence of PE in CF patients undergoing CTPA for suspected PE was 4%, which is lower than predicted by the Revised Geneva Score. This may be due to a large overlap in the signs and symptoms of PE and exacerbations of CF lung disease.
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Affiliation(s)
- Kathleen Suzanne Mahan
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota, Twin Cities Minneapolis Minnesota USA
| | - Hamna Ahmad
- Division of Pulmonary, Allergy, and Critical Care Medicine Hennepin Healthcare Minneapolis Minnesota USA
| | - Andrew George Keenan
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota, Twin Cities Minneapolis Minnesota USA
| | - Matthew Erren Prekker
- Division of Pulmonary, Allergy, and Critical Care Medicine Hennepin Healthcare Minneapolis Minnesota USA
| | - Robert Ralph Kempainen
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota, Twin Cities Minneapolis Minnesota USA
- Division of Pulmonary, Allergy, and Critical Care Medicine Hennepin Healthcare Minneapolis Minnesota USA
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Abstract
Cystic fibrosis (CF) is the most common fatal genetic disease in North America. While CF is more common among Whites, it is increasingly being recognized in other races and ethnicities. Although there is no cure, life expectancy has steadily improved, with the median survival exceeding 46 years in the United States. There are now more adults than children with CF in the United States. CF is caused by mutations in a gene that encodes the cystic fibrosis transmembrane conductance regulator (CFTR) protein, expressed in many epithelial cells. More than 2100 CFTR mutations have been linked to CF, and newer CFTR modulator drugs are being used to improve the production, intracellular processing, and function of the defective CFTR protein. CF is a multisystem disease that affects primarily the lungs, pancreas, hepatobiliary system, and reproductive organs. Anesthesiologists routinely encounter CF patients for various surgical and medical procedures, depending on the age group. This review article focuses on the changing epidemiology of CF, advances in the classification of CFTR mutations, the latest innovations in CFTR modulator therapies, the impact of the coronavirus disease pandemic, and perioperative considerations that anesthesiologists must know while caring for patients with CF.
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Affiliation(s)
- Amy J Lee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Eryn L Thiele
- Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia
| | - Pamela L Zeitlin
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Debnath Chatterjee
- From the Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Roe AH, Merjaneh L, Oxman R, Hughan KS. Gynecologic health care for females with cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100277. [PMID: 34849351 PMCID: PMC8607192 DOI: 10.1016/j.jcte.2021.100277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
Females with CF may have cyclic lung symptoms, yeast infections, and urinary incontinence. Contraception is safe, but comorbidities should be considered in method selection. Females with CF have reduced fertility, though the etiology is unknown. Females with CF underutilize basic preventive gynecologic services.
As females with cystic fibrosis (CF) increasingly reach their reproductive years, gynecologic issues have become an important area of clinical care and research. First, females with CF may have disease-specific gynecologic problems, including cyclic pulmonary symptoms, vaginal yeast infections, and urinary incontinence. Next, contraceptive methods are thought to be overall safe and effective, however further research is needed to confirm this and to understand the lower rates of uptake among females with CF compared to the general population. Further, females with CF have reduced fertility, although the etiology of this is unknown and under investigation. While assisted reproductive technologies may help achieve pregnancy, decision-making around parenthood remains complex. Finally, while patients and providers agree on the importance of sexual and reproductive health care, females with CF underutilize basic preventive services such as cervical cancer screening, and better approaches are needed to bridge the gap with gynecology. In this review, we discuss the current state of gynecologic care for females with CF, as well as clinical and research opportunities for improvement.
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Affiliation(s)
- Andrea H. Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, United States
- Corresponding author.
| | - Lina Merjaneh
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, WA 98115, United States
| | - Rachael Oxman
- Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Kara S. Hughan
- Division of Pediatric Endocriology and Metabolism, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, United States
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Holsteen P, Meier M, Brennan L, VanHorn T, Kuldanek SA, Wang M, Martiniano SL. Safety and effectiveness of a risk-stratified venous thromboembolism prophylaxis algorithm in young people with cystic fibrosis. Thromb Res 2021; 206:36-41. [PMID: 34399123 DOI: 10.1016/j.thromres.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with cystic fibrosis (CF) have an increased risk of thrombosis due to acquired thrombophilia secondary to chronic systemic inflammation and central venous catheter use for treatment of pulmonary infections. The objective of this study is to determine the safety and effectiveness of a risk-stratified, venous thromboembolism (VTE) prophylaxis intervention. METHODS This single-center, IRB-approved, retrospective study assessed patients with CF admitted to our institution for treatment of a pulmonary exacerbation from 2017 to 2019. Data and outcomes were manually extracted from the electronic medical record and internal CF clinical database. Subject characteristics, calculated VTE risk, prophylaxis interventions prescribed, VTE incidence, and adverse events were captured. RESULTS A total of 135 CF patients had 354 admissions for pulmonary exacerbations in the time frame of the study. The majority of admissions (88.7%) were classified as moderate or high risk for VTE using the algorithm. Overall, VTE prophylaxis intervention determined by the algorithm was initiated in 36.2% of admissions. During the study period, no VTE events occurred. Four minor bleeding adverse effects were reported in patients receiving VTE chemical prophylaxis with enoxaparin (4.2%). CONCLUSIONS This study provides the first reported outcomes following implementation of a risk-stratified VTE prophylaxis algorithm in hospitalized young people with CF. In this population at increased risk, use of risk-stratified prophylaxis was safe and effective in preventing VTE. Additional work to improve and maintain adherence to the algorithm and VTE prophylaxis interventions at our institution is planned and similar care should be considered at other pediatric CF care centers.
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Affiliation(s)
- Page Holsteen
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Maxene Meier
- Center for Research in Outcomes for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laney Brennan
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Tracie VanHorn
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Susan A Kuldanek
- Hemophilia & Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Wang
- Hemophilia & Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stacey L Martiniano
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Children's Hospital Colorado and the University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Morrison JM, Betensky M, Kiskaddon AL, Goldenberg NA. Venous Thromboembolism among Noncritically Ill Hospitalized Children: Key Considerations for the Pediatric Hospital Medicine Specialist. Semin Thromb Hemost 2021; 48:434-445. [PMID: 33962474 DOI: 10.1055/s-0041-1729170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and preventable harm among noncritically ill hospitalized children. Several clinical factors relevant to the noncritically ill hospitalized child significantly increase the risk of VTE including the presence of central venous catheters, systemic inflammation, and prolonged immobilization. Although risk mitigation strategies have been described, the diagnosis, treatment, and prevention of VTE require standardization of institutional practices combined with multidisciplinary collaboration among pediatric hospitalists, hematologists, and other care providers. In this narrative review, we summarize the epidemiology of VTE, risk models identifying high-risk conditions associated with VTE, and prevention and treatment strategies. We further describe successful quality improvement efforts implementing institutional VTE risk stratification and thromboprophylaxis procedures. Finally, we highlight unique challenges facing pediatric hospital medicine specialists in the era of the COVID-19 pandemic, including caring for adults admitted to pediatric hospital units, and describe future research opportunities for VTE in the noncritically ill hospitalized child.
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Affiliation(s)
- John M Morrison
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Marisol Betensky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hematology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Amy L Kiskaddon
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Neil A Goldenberg
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Pediatric Hematology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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9
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Gavioli EM, Pao K, Harrington M. A retrospective evaluation of vitamin K for hemoptysis in adult cystic fibrosis patients. Hosp Pract (1995) 2021; 49:262-265. [PMID: 33726579 DOI: 10.1080/21548331.2021.1905413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Hemoptysis is a complication in cystic fibrosis (CF) patients, and is associated with pulmonary exacerbations and hospitalizations. Pancreatic insufficiency is common in CF patients, and therefore these patients may benefit from the use of vitamin K therapy. METHODS This was an observational study conducted in adult CF patients aiming to describe the utilization of vitamin K therapy in the setting of hemoptysis during an acute CF pulmonary exacerbation. An evaluation of hospital length of stay, time until the next pulmonary exacerbation, and 30-day re-admission rates were evaluated in CF patients who presented with hemoptysis and received vitamin K therapy. RESULTS The average dose of vitamin K therapy was 10 mg for an average duration of 4.9 ± 0.55 days for 38 adult CF patients included in this cohort. The median length of stay among patients who received vitamin K therapy was 8 days (IQR: 6-12 days). The median time until next hospital admission was 127 days (95% CI: 71.4 to 182.6 days), and the 30-day readmission rates were 7.89%. Two patients developed a thromboembolism after receiving vitamin K therapy. CONCLUSIONS Evidence for the use of vitamin K therapy in the setting of CF-related hemoptysis remains unclear, and warrants further safety and efficacy evaluation. Further prospective studies are needed to determine the appropriateness of dosing and duration of vitamin K therapy, as well as determining its role in the setting of the varying levels of hemoptysis during a pulmonary CF exacerbation.
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Affiliation(s)
- Elizabeth Marie Gavioli
- Arnold and Marie Schwartz College of Pharmacy and Health Sciences, 1 University Plaza, Brooklyn, New York, United States.,Mount Sinai Beth Israel Hospital, New York, United States
| | - Kevin Pao
- Mount Sinai Beth Israel Hospital, New York, United States
| | - Matthew Harrington
- Mount Sinai Beth Israel Hospital, New York, United States.,Icahn School of Medicine at Mount Sinai, New York, United States
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Hughan KS, Daley T, Rayas MS, Kelly A, Roe A. Female reproductive health in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S95-S104. [PMID: 31679735 DOI: 10.1016/j.jcf.2019.08.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023]
Abstract
Women with cystic fibrosis (CF) are living longer and healthier lives, and opportunities for childbearing are increasingly promising. However, this population can also face sexual and reproductive health concerns, including menstrual irregularities, unplanned pregnancies, infertility and pregnancy complications. Additionally, more women are entering menopause and are at risk for the consequences of estrogen deficiency. The exact mechanisms involved in female reproductive health conditions in CF are not clearly understood, but are thought to include cystic fibrosis transmembrane regulator (CFTR)-mediated abnormalities, changes in female sex hormones, and other CF health-related factors. In the era of CFTR modulator therapy, new data are necessary to understand the impact of CFTR modulation on contraceptive effectiveness, fertility, and pregnancy outcomes to help guide future clinical care. This article reviews the current scientific knowledge of major reproductive health issues for women with CF.
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Affiliation(s)
- Kara S Hughan
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA, USA.
| | - Tanicia Daley
- Division of Pediatric Endocrinology and Metabolism, Emory Children's Pediatric Institute, Emory University School of Medicine, 1400 Tullie Road, Atlanta, GA, USA
| | - Maria Socorro Rayas
- Division of Pediatric Endocrinology and Diabetes, University of Texas Health San Antonio, 7703 Floyd Curl, San Antonio, TX, USA
| | - Andrea Kelly
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Philadelphia, PA, USA
| | - Andrea Roe
- Division of Family Planning, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, 1000 Courtyard, 3400 Spruce Street, Philadelphia, PA, USA
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Scott JA, Barry PJ, Jones AM, Athwal VS. Management of superior mesenteric venous thrombus in cystic fibrosis related liver disease. Paediatr Respir Rev 2020; 35:106-108. [PMID: 32798114 DOI: 10.1016/j.prrv.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
Abdominal pain is a common feature in patients with cystic fibrosis (CF) and CF related liver disease (CFLD). Superior mesenteric venous (SMV) thrombosis is an uncommon but important cause of abdominal pain. Management strategies are complicated by an underlying prothrombotic state and increased risk of bleeding from complications of CF and CFLD. This review addresses clinical presentation, detection and management options of an acute SMV thrombus in the context of CF.
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Affiliation(s)
- J A Scott
- Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK; Divsion of Diabetes, Endocrine and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
| | - P J Barry
- Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK
| | - A M Jones
- Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK
| | - V S Athwal
- Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK; Divsion of Diabetes, Endocrine and Gastroenterology, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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12
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Gavioli E, Aung CC. Haemoptysis management in cystic fibrosis: A case report and treatment pathway. J Clin Pharm Ther 2020; 45:845-847. [DOI: 10.1111/jcpt.13179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Gavioli
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn New York
- Mount Sinai Beth Israel New York New York
| | - Cho Cho Aung
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences Brooklyn New York
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13
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Ratté MT, Jones AE, Witt DM, Young DC. Survey of current treatment practices for venous thromboembolism in patients with cystic fibrosis. Pediatr Pulmonol 2020; 55:149-155. [PMID: 31502767 DOI: 10.1002/ppul.24512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) and venous thromboembolism (VTE) pose therapeutic challenges including potential drug interactions between CF-related therapies and anticoagulants. Despite these challenges, there are no recommendations for VTE management specific to patients with CF. Our objective was to describe VTE treatment practices among Cystic Fibrosis Foundation (CFF)-accredited care centers and affiliate programs in the United States. METHODS An online survey was distributed to CF center directors. The survey included questions regarding centers' demographics and posed a series of hypothetical clinical scenarios to gather centers' VTE treatment practices including choice of anticoagulant, dosing practices, duration decisions, and monitoring efforts. Descriptive statistics were utilized to summarize the survey results. RESULTS The survey response rate was 56.3%. Most centers reported treating zero to five VTE episodes per year. The following anticoagulants were used most often for VTE treatment: low-molecular-weight heparin (LMWH) (73.2%), apixaban (36.6%), warfarin (35.2%), rivaroxaban (33.8%), and unfractionated heparin (18.3%). On a scale of 0 to 100, the median confidence level in managing anticoagulant therapy was 50. Many centers expressed a desire for a CF-specific VTE treatment guideline. The most commonly cited challenging clinical situations were managing anticoagulant therapy complications (26.5%) and drug-drug interactions (21.3%). For common VTE scenarios, pediatric patients were most often treated with LMWH and warfarin, whereas adult patients were more often treated with apixaban or rivaroxaban. CONCLUSIONS Survey results indicated CF care centers find managing VTE in patients with CF challenging and indicated that a CF-specific VTE treatment guideline would be helpful.
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Affiliation(s)
- Morgan T Ratté
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah
| | - Aubrey E Jones
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Daniel M Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - David C Young
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
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Nossair F, Mahajerin A, Hoang J, Diaz D, Nugent D. Promising biomarkers for the prediction of catheter-related venous thromboembolism in hospitalized children: An exploratory study. Pediatr Blood Cancer 2019; 66:e27870. [PMID: 31222954 DOI: 10.1002/pbc.27870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric venous thromboembolism (VTE) has increased over the past 10 years, with central venous catheters (CVC) being the strongest risk factor. Current tools are not sufficient to predict VTE risk. The utility of biomarkers in predicting CVC-related VTE has been minimally explored. Our objective is to determine the utility of microparticles (MPs), factor VIII (FVIII) activity, and thrombin generation (TG) in prospectively predicting VTE occurrence in hospitalized children with CVCs. PROCEDURE In this nested case-control pilot study, consecutive hospitalized children needing CVC placement (1 month to 21 years) were enrolled. Venous samples were collected prior to or within 24 h of CVC placement. MPs were measured using factor Xa initiated clot-based assay. FVIII was measured using a one-stage clot-based assay. TG was measured using calibrated automated thrombogram. RESULTS There were three CVC-related VTE events (7%) in our cohort of 42 subjects. Xa clotting time (XaCT) ratio was lower (0.68 ± 0.07 vs 0.95 ± 0.21, P = .4), while FVIII (461 ± 120 vs 267 ± 130, P = .02), peak thrombin (418 ± 89 vs 211 ± 101, P = .001), endogenous thrombin potential (ETP) (1828 ± 485 vs 1282 ± 394, P = .03), and velocity index (VI) (182 ± 28 vs 75 ± 53, P = .001) were higher in subjects with CVC-related VTE compared to those without CVC-related VTE. Sensitivity/specificity analysis revealed optimal cutoff values for XaCT ratio (0.75), FVIII (370), ETP (1680), peak (315), and VI (130), with receiver operating characteristic area under the curve values >0.9. CONCLUSION MPs, FVIII, and TG can potentially predict pediatric CVC-related VTE in a prospective fashion. Stratification according to VTE risk may aid in guiding preventative efforts in future studies.
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Affiliation(s)
- Fadi Nossair
- Division of Hematology Oncology, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's, Orange, California.,University of California - Irvine, Irvine, California
| | - Janet Hoang
- Division of Hematology, CHOC Children's, Orange, California
| | - Daniel Diaz
- Division of Hematology, CHOC Children's, Orange, California
| | - Diane Nugent
- Division of Hematology, CHOC Children's, Orange, California.,University of California - Irvine, Irvine, California
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Hatziparasides G, Loukou I, Moustaki M, Douros K. Vitamin K and cystic fibrosis: A gordian knot that deserves our attention. Respir Med 2019; 155:36-42. [PMID: 31295676 DOI: 10.1016/j.rmed.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 01/16/2023]
Abstract
Cystic fibrosis (CF) is an inherited genetic disorder with multiorgan involvement. Gastrointestinal tract dysfunction leads to fat and fat-soluble vitamins (A,D,E,K) malabsorption and deficiency of these vitamins. Subclinical vitamin K (VK) deficiency seems to be a common problem in CF patients. However, despite the rest of fat-soluble vitamins being routinely supplemented, this is not a universal clinical practice for VK. Inefficient levels of VK may have significant effects on blood coagulation and bone formation. There are also some data indicating that VK may play a key role on regulation of inflammation. Supplementing CF patients with VK seems rational, but the appropriate dosing regimens are still a matter of debate. This review will try to delineate the problem and communicate the latest opinions on this controversial issue.
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Affiliation(s)
- Gregorios Hatziparasides
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, University General Hospital "Attikon", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Dept, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Moustaki
- Cystic Fibrosis Dept, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, University General Hospital "Attikon", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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16
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Delacoste J, Feliciano H, Yerly J, Dunet V, Beigelman‐Aubry C, Ginami G, van Heeswijk RB, Piccini D, Stuber M, Sauty A. A black‐blood ultra‐short echo time (UTE) sequence for 3D isotropic resolution imaging of the lungs. Magn Reson Med 2019; 81:3808-3818. [DOI: 10.1002/mrm.27679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Jean Delacoste
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Helene Feliciano
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Jérôme Yerly
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne Switzerland
| | - Vincent Dunet
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Catherine Beigelman‐Aubry
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
| | - Giulia Ginami
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- School of Biomedical Engineering and Imaging Sciences King’s College London London United Kingdom
| | - Ruud B. van Heeswijk
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne Switzerland
| | - Davide Piccini
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Advanced Clinical Imaging Technology Siemens Healthcare AG Lausanne Switzerland
| | - Matthias Stuber
- Department of Radiology University Hospital (CHUV) and University of Lausanne (UNIL) Lausanne Switzerland
- Center for Biomedical Imaging (CIBM) Lausanne Switzerland
| | - Alain Sauty
- Adult CF unit, Neuchatelois‐Pourtales Hospital Neuchatel Switzerland
- Service of Pneumology, Department of Medicine University Hospital (CHUV) Lausanne Switzerland
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17
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Zeynelabidin S, Klouwer FCC, Meijers JCM, Suijker MH, Engelen M, Poll-The BT, van Ommen CH. Coagulopathy in Zellweger spectrum disorders: a role for vitamin K. J Inherit Metab Dis 2018; 41:249-255. [PMID: 29139025 PMCID: PMC5830475 DOI: 10.1007/s10545-017-0113-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Zellweger spectrum disorders (ZSDs) are caused by an impairment of peroxisome biogenesis, resulting in multiple metabolic abnormalities. This leads to a range of symptoms, including hepatic dysfunction and coagulopathy. This study evaluated the incidence and severity of coagulopathy and the effect of vitamin K supplementation orally and IV in ZSD. METHODS Data were retrospectively retrieved from the medical records of 30 ZSD patients to study coagulopathy and the effect of vitamin K orally on proteins induced by vitamin K absence (PIVKA-II) levels. Five patients from the cohort with a prolonged prothrombin time, low factor VII, and elevated PIVKA-II levels received 10 mg of vitamin K IV. Laboratory results, including thrombin generation, at baseline and 72 h after vitamin K administration were examined. RESULTS In the retrospective cohort, four patients (13.3%) experienced intracranial bleedings and 14 (46.7%) reported minor bleeding. No thrombotic events occurred. PIVKA-II levels decreased 38% after start of vitamin K therapy orally. In the five patients with a coagulopathy, despite treatment with oral administration of vitamin K, vitamin K IV caused an additional decrease (23%) of PIVKA-II levels and increased thrombin generation. CONCLUSION Bleeding complications frequently occur in ZSD patients due to liver disease and vitamin K deficiency. Vitamin K deficiency is partly corrected by vitamin K supplementation orally, and vitamin K administered IV additionally improves vitamin K status, as shown by further decrease of PIVKA-II and improved thrombin generation.
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Affiliation(s)
- Sara Zeynelabidin
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Femke C C Klouwer
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | - Monique H Suijker
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Bwee Tien Poll-The
- Department of Pediatric Neurology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - C Heleen van Ommen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Spiwak E, Wiesenauer C, Panigrahi A, Raj A. Use of Pleuroperitoneal Shunt in Chylothorax Related to Central Line Associated Thrombosis in Sickle Cell Disease. Children (Basel) 2018; 5:children5010007. [PMID: 29301288 PMCID: PMC5789289 DOI: 10.3390/children5010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022]
Abstract
Central vein thrombosis as a cause of chylothorax is uncommon, and in a few cases in the literature was related to thrombotic complications of central venous access devices (CVAD). Superior vena cava (SVC) occlusion-induced chylothorax has been described in adult sickle cell disease (SCD) in a setting of chronic indwelling CVAD. There are limited reports on chylothorax induced by central venous thrombosis secondary to chronic CVAD in children with SCD. We describe an 8-year-old male patient, with a history of SCD, maintained on long term erythrocytapheresis for primary prevention of stroke, and whose clinical course was complicated by chylothorax which was successfully treated with a pleuroperitoneal shunt.
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Affiliation(s)
- Elizabeth Spiwak
- Department of Pediatrics, University of Louisecille, Louisville, KY 40202, USA.
| | - Chad Wiesenauer
- Department of Pediatric Surgery, University of Louisville, Louisville, KY 40202, USA.
| | - Arun Panigrahi
- Department of Pediatric Hematology-Oncology, UC Davis, University of California, Sacramento, CA 95817, USA.
| | - Ashok Raj
- Department of Pediatric Hematology-Oncology, University of Louisville, Louisville, KY 40206, USA.
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Abstract
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT), and pulmonary embolism (PE), is becoming increasingly recognized as a cause of morbidity and mortality in pediatrics, particularly among hospitalized children. Furthermore, evidence is accumulating that suggests the inflammatory response may be a cause, as well as consequence, of VTE, but current anticoagulation treatment regimens are not designed to inhibit inflammation. In fact, many established clinical VTE risk factors such as surgery, obesity, cystic fibrosis, sepsis, systemic infection, cancer, inflammatory bowel disease, and lupus likely modulate thrombosis through inflammatory mediators. Unlike other traumatic mechanisms of thrombosis involving vascular transection and subsequent exposure of subendothelial collagen and other procoagulant extracellular matrix materials, inflammation of the vessel wall may initiate thrombosis on an intact vein. Activation of endothelial cells, platelets, and leukocytes with subsequent formation of microparticles can trigger the coagulation system through the induction of tissue factor (TF). Identification of biomarkers to evaluate VTE risk could be of great use to the clinician caring for a patient with inflammatory disease to guide decisions regarding the risk:benefit ratio of various types of potential thromboprophylaxis strategies, or suggest a role for anti-inflammatory therapy. Unfortunately, no such validated inflammatory scoring system yet exists, though research in this area is ongoing. Elevation of C-reactive protein, IL-6, IL-8, and TNF-alpha during a response to systemic inflammation have been associated with increased VTE risk. Consequent platelet activation enhances the prothrombotic state, leading to VTE development, particularly in patients with other risk factors, most notably central venous catheters.
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Affiliation(s)
- Brian R Branchford
- University of Colorado Hemophilia and Thrombosis Center, Pediatric Hematology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Shannon L Carpenter
- Kansas City Regional Hemophilia Treatment Center, Pediatric Hematology, UMKC School of Medicine and Children's Mercy Hospital, Kansas, CO, United States
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20
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May TL, Gifford AH, Lahiri T, Black A, Trang J, Cornell AG, Gonzalez K, Morin S, Napier M, Duarte CW, Zuckerman JB. Complications of long and intermediate term venous catheters in cystic fibrosis patients: A multicenter study. J Cyst Fibros 2018; 17:96-104. [PMID: 28579360 DOI: 10.1016/j.jcf.2017.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) or peripherally inserted central venous catheters (PICCs) are commonly used in the care of patients with cystic fibrosis (CF), but they are associated with various complications, including thrombosis, infection, and insertion site symptoms. METHODS We conducted a retrospective review of PICC and TIVAD use in adults and children with CF over an 8-year period at 3 accredited care centers. Patient attributes included CFTR genotype, comorbidities, lung function, body mass index, use of anticoagulation, and respiratory tract microbiology. Catheter data included line type, caliber, and lumen number. We assessed practice variation by surveying physicians. RESULTS In a population of 592 CF patients, 851 PICC and 61 TIVADs were placed between January 1, 2003 and July 1, 2011. Larger catheter caliber and increased lumen number were risk factors for PICC complications in adults. Patient-related risk factors for PICC complications included poor nutritional status, infection with Burkholderia cepacia spp., and having ≥5 lines inserted during the study period. The probability of a PICC complication varied across centers (2.6% to 14.1%, p=0.001) and remained significant after adjustment for patient-and line-related risk factors. The median complication-free survival of TIVADs, however, did not vary significantly by center (p=0.85). CONCLUSIONS This is the first longitudinal, multicenter assessment of complication rates for PICCs and TIVADs in a large cohort of adults and children with CF. Specific patient- and catheter-related characteristics were associated with increased risk of complications. Center effects on complication rates were observed for PICCs.
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21
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King CS, Valentine V, Cattamanchi A, Franco-Palacios D, Shlobin OA, Brown AW, Singh R, Bogar L, Nathan SD. Early postoperative management after lung transplantation: Results of an international survey. Clin Transplant 2017; 31. [PMID: 28425132 DOI: 10.1111/ctr.12985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little data exist regarding optimal therapeutic strategies postoperatively after lung transplant (LTx). Current practice patterns rely on expert opinion and institutional experience resulting in nonuniform postoperative care. To better define current practice patterns, an international survey of LTx clinicians was conducted. METHODS A 30-question survey was sent to transplant clinicians via email to the International Society of Heart and Lung Transplantation open forum mailing list and directly to the chief transplant surgeon and pulmonologist of all LTx centers in the United States. RESULTS Fifty-two clinicians representing 10 countries responded to the survey. Sedatives use patterns included: opiates + propofol (57.2%), opiates + dexmedetomidine (18.4%), opiates + intermittent benzodiazepines (14.3%), opiates + continuous benzodiazepines (8.2%), and opiates alone (2%). About 40.4% reported no formal sedation scale was followed and 13.5% of programs had no formal policy on sedation and analgesia. A lung protective strategy was commonly employed, with 13.8%, 51.3%, and 35.9% of respondents using tidal volumes of <6 mL/kg ideal body weight (IBW), 6 mL/kg IBW, and 8 mL/kg IBW, respectively. CONCLUSION Practice patterns in the early postoperative care of lung transplant recipients differ considerably among centers. Many of the reported practices do not conform to consensus guidelines on management of critically ill patients.
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Affiliation(s)
- Christopher S King
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Vincent Valentine
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashok Cattamanchi
- Critical Care, Department of Medicine, UNC Rex Health Care, Raleigh, NC, USA
| | | | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - A Whitney Brown
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Ramesh Singh
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Linda Bogar
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
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Anıl H, Kılıç Yıldırım G, Harmancı K, Bozkurt Turhan A, Akay OM, Bör Ö, Aydoğdu S, Kocak A. Thromboelastogram as a Tool to Predict Hypercoagulability in Children With Cystic Fibrosis. Clin Appl Thromb Hemost 2016; 24:348-352. [PMID: 28030968 DOI: 10.1177/1076029616683045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increased thrombophilic tendency in patients with cystic fibrosis (CF) has recently been reported. The determinants of thrombosis in children with CF remain largely unknown. Our aim in this study was to evaluate the thromboelastography (TEG) profile of children with CF through ROTEM (whole blood rotation thromboelastometry). Nineteen patients with CF and 20 controls were included in the study. Whole blood count, prothrombin time, activated prothrombin time, fibrinogen, d-dimer levels, and ROTEM assays (INTEM, EXTEM) were performed. Clotting time, clot formation time (CFT), and maximum clot firmness (MCF) were determined by INTEM and EXTEM analysis. In INTEM assay, MCF ( P = .001) value was significantly increased and CFT ( P = .031) value was decreased in patients with CF compared with those of the control group. In the EXTEM assay, there was a similar significant increase in MCF ( P = .023) value in patients with CF compared with that of the control group. There was a significant positive correlation between fibrinogen levels and MCF in EXTEM ( r = .72) and INTEM ( r = .76) assays, whereas there was a negative correlation with CFT in EXTEM ( r = -.61) and INTEM ( r = -.67). The results of our study indicated that TEG profiles in patients with CF were more hypercoagulable compared with those of the control group.
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Affiliation(s)
- Hülya Anıl
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Gonca Kılıç Yıldırım
- 2 Department of Pediatric Nutrition and Metabolism, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Koray Harmancı
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Ayşe Bozkurt Turhan
- 3 Department of Pediatric Hematology and Oncology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Olga Meltem Akay
- 4 Department of Hematology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Özcan Bör
- 3 Department of Pediatric Hematology and Oncology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Sultan Aydoğdu
- 2 Department of Pediatric Nutrition and Metabolism, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Abdulkadır Kocak
- 1 Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
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Yan Y, Ji Y, Su N, Mei X, Wang Y, Du S, Zhu W, Zhang C, Lu Y, Xing XH. Non-anticoagulant effects of low molecular weight heparins in inflammatory disorders: A review. Carbohydr Polym 2016; 160:71-81. [PMID: 28115102 DOI: 10.1016/j.carbpol.2016.12.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/30/2016] [Accepted: 12/18/2016] [Indexed: 01/26/2023]
Abstract
Low molecular weight heparins (LMWHs) are produced by chemical or enzymatic depolymerization of unfractionated heparin (UFH). Besides their well-known anticoagulant effects, LMWHs have also been reported to exhibit numerous anti-inflammatory properties. Previous studies have, however, shown that different production processes result in unique structural characteristics of LMWHs. The structural variations may help explain the different therapeutic spectrums in disease treatment for non-anticoagulant effects. In the present review, we summarize major advances in understanding and exploiting the anti-inflammatory disorder activities of LMWHs, based on mechanistic studies, preclinical experiments and clinical trials. We highlight differences in these activities of commercially available LMWHs produced using different manufacturing processes. We stress the importance of structure-activity relationship (SAR) studies on the non-anticoagulant effects of LMWHs and discuss strategies for exploring new clinical indications.
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Affiliation(s)
- Yishu Yan
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Yang Ji
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Nan Su
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Xiang Mei
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China
| | - Yi Wang
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Shanshan Du
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Wenming Zhu
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Chong Zhang
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Yuan Lu
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
| | - Xin-Hui Xing
- Key Laboratory for Industrial Biocatalysis, Ministry of Education, Institute of Biochemical Engineering, Department of Chemical Engineering, Centre for Synthetic and Systems Biology, Tsinghua University, Room 607, Yingshi Building, Beijing 100084, China.
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Whiteman MK, Oduyebo T, Zapata LB, Walker S, Curtis KM. Contraceptive safety among women with cystic fibrosis: a systematic review. Contraception 2016; 94:621-629. [PMID: 27287694 PMCID: PMC11025598 DOI: 10.1016/j.contraception.2016.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/27/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND With dramatic improvements in life expectancy for cystic fibrosis (CF) patients, contraception for women with CF has become an important issue. There are theoretical concerns that hormonal contraceptive use among women with CF may impact disease severity or risk for other adverse health outcomes, including thrombosis and poor bone health, as well as concerns that malabsorption or altered drug metabolism might impact contraceptive effectiveness. OBJECTIVE To evaluate evidence on the safety and effectiveness of contraceptive methods among women with CF. SEARCH STRATEGY We searched the PubMed database for all articles published from database inception through October 2015. SELECTION CRITERIA We included studies that examined measures of disease severity, other health outcomes or indicators of contraceptive effectiveness among women with CF initiating or continuing a contraceptive method. RESULTS Seven studies met our inclusion criteria. Three observational studies of fair to poor quality suggest that use of oral contraceptives (OCs) does not negatively impact CF disease severity, defined as changes in pulmonary function, number of exacerbations or need for intravenous antibiotics. Three small studies of poor quality reported on contraceptive failure among women with CF using combined hormonal contraceptives (combined OCs, patch or ring). One pregnancy was reported in a patch user out of 43 hormonal contraceptive users across all studies. One pharmacokinetic study reported that women with CF achieve steroid hormone plasma concentrations similar to healthy women after ingestion of combined OCs. CONCLUSIONS Limited evidence suggests that hormonal contraceptive use does not negatively impact disease severity among women with CF and that hormonal contraceptive effectiveness is not impaired by CF. Studies were limited by small sample sizes and short duration of follow-up. No studies examined the effect of hormonal contraception on thrombosis or bone health among women with CF.
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Affiliation(s)
- Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Seth Walker
- Emory University Adult Cystic Fibrosis Program, Atlanta, GA, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Magnusson M, Ignjatovic V, Hardikar W, Monagle P. A conceptual and practical approach to haemostasis in paediatric liver disease. Arch Dis Child 2016; 101:854-9. [PMID: 27013527 DOI: 10.1136/archdischild-2015-309535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 03/02/2016] [Indexed: 12/15/2022]
Abstract
UNLABELLED Children with liver disease can develop severe bleeding episodes and thrombosis. Liver failure usually results in decreased levels of procoagulant and anticoagulant factors. Additional risk factors, including changes in vascular flow and endothelial function, are of importance for the development of bleeding or thrombosis in individual vascular beds. Detailed studies of haemostatic disturbances in the setting of paediatric liver disease are sparse and extrapolation from adult studies is common. The spectrum of liver diseases and the haemostatic system differs between children and adults. Specific paediatric liver diseases are reported to have more distinctive effects on haemostasis and the risk of bleeding and/or thrombosis. CONCLUSION we propose a model regarding haemostasis in paediatric liver disease, taking into account a number of specific variables and mechanisms, as well as the type of liver disease, which will provide a framework for clinical decision-making in these complex patients.
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Affiliation(s)
- Maria Magnusson
- CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden MMK, Clinical Chemistry and Blood Coagulation Research, Karolinska Institutet, Stockholm, Sweden Department of Paediatrics, University of Melbourne, Melbourne, Australia Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Winita Hardikar
- Department of Paediatrics, University of Melbourne, Melbourne, Australia Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia
| | - Paul Monagle
- Department of Paediatrics, University of Melbourne, Melbourne, Australia Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia
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Bansal M, Ren CL. Anti-coagulant therapy with dabigatran for cystic fibrosis patients. Pediatr Pulmonol 2016; 51:E29-30. [PMID: 27128852 DOI: 10.1002/ppul.23419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/10/2016] [Accepted: 03/28/2016] [Indexed: 11/09/2022]
Abstract
Patients with cystic fibrosis (CF) are at increased risk of venous thromboembolism, especially in association with central venous catheter use. Coumarin drugs and low molecular weight heparin are frequently used for anti-coagulant therapy, but are more challenging to administer in CF patients. Dabigatran, an oral thrombin antagonist, is an alternative anti-coagulant medication, but its use in CF has not been reported. We describe our experience in successfully using dabigatran for long-term anti-coagulation therapy in two CF patients. Our experience suggests that dabigatran can serve as an option for anticoagulation therapy in CF. Pediatr Pulmonol. 2016;51:E29-E30. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Manvi Bansal
- Division of Pediatric Pulmonology, Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Clement L Ren
- Division of Pediatric Pulmonology, Golisano Children's Hospital, University of Rochester, Rochester, New York
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Otani S, Westall GP, Levvey BJ, Marasco S, Lyon S, Snell GI. Managing central venous obstruction in cystic fibrosis recipients--lung transplant considerations. J Cyst Fibros 2014; 14:255-61. [PMID: 25174332 DOI: 10.1016/j.jcf.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/29/2014] [Accepted: 08/03/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The superior vena cava (SVC) syndrome in cystic fibrosis (CF) patients is rare, but presents unique challenges in the peri-transplant period. We reviewed our experience of SVC syndrome in CF recipients undergoing lung transplantation. METHODS This is a retrospective case series from a single center chart-review. SVC obstruction is defined by clinically significant stenosis or obstruction of the SVC as detected by contrast studies. RESULTS We identified SVC obstruction in seven post-transplant cases and one pre-transplant case. All eight patients had previous or current history of indwelling central venous catheters. Three recipients experienced operative complications. Five of the seven recipients suffered at least one episode of post-operative SVC obstruction or bleeding despite prophylactic anticoagulation. At a median follow-up of 29 months, six of the seven patients transplanted are well. CONCLUSIONS Strategies are available to minimize the risks of intra/peri-operative acute life-threatening SVC obstruction in CF patients.
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Affiliation(s)
- Shinji Otani
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Glen P Westall
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Bronwyn J Levvey
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Stuart Lyon
- Medical Imaging Department, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Gregory I Snell
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, 55 Commercial Road, Melbourne, VIC 3004, Australia.
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Munck A, Kheniche A, Alberti C, Hubert D, Martine RG, Nove-Josserand R, Pin I, Bremont F, Chiron R, Couderc L, Dalphin ML, Darviot E, Delaisi B, Dominique S, Durieu I, Fanton A, Fayon M, Gérardin M, Giniès JL, Giraut C, Grenet D, Guillot M, Huet F, Le Bourgeois M, Murris-Epin M, Ramel S, Sardet A, Sermet-Gaudelus I, Varaigne F, Wanin S, Weiss L, Hurtaud MF. Central venous thrombosis and thrombophilia in cystic fibrosis: A prospective study. J Cyst Fibros 2014; 14:97-103. [PMID: 25107684 DOI: 10.1016/j.jcf.2014.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Catheter venous thrombosis may result in life-threatening embolic complications. Recently, a thrombophilic tendency was described in cystic fibrosis (CF), the significance of which remains unclear. The aims of this study were to (1) document the frequency of catheter venous thrombosis detected by colour-Doppler-ultrasound (Doppler-US), (2) assess genetic and acquired thrombophilia risk factors for catheter venous thrombosis and hypercoagulability status and (3) provide recommendations on laboratory screening when considering insertion of a totally implantable vascular access device (TIVAD) in CF patients. METHODS We designed a multicentre prospective study in patients selected at the time of catheter insertion. Doppler-US was scheduled at 1 and 6months after insertion and before insertion in case of a previous central line. Blood samplings were drawn at insertion and at 1 and 6months later. RESULTS One-hundred patients received a TIVAD and 90 completed the 6-month study. Prevalence of thrombophilia abnormalities and hypercoagulability was found in 50% of the cohorts. Conversely, catheter venous thrombosis frequency was low (6.6%). CONCLUSION Our data do not support biological screening at the time of a TIVAD insertion. We emphasise the contribution of a medical history of venous thromboembolism and prospective Doppler-US for identifying asymptomatic catheter venous thrombosis to select patients who may benefit from biological screening and possible anticoagulant therapy.
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Affiliation(s)
- Anne Munck
- Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paediatric Gastroenterology and Respiratory Department, CF Centre, Université Paris 7, France.
| | - Ahmed Kheniche
- Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Imaging Department, Université Paris 7, France
| | - Corinne Alberti
- Université Paris Diderot, Sorbonne Paris Cité, France; Inserm, CIE 5, Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Clinical Epidemiology Unit, Paris, France
| | - Dominique Hubert
- Assistance publique-Hôpitaux de Paris, Hôpital Cochin, CF Centre, Université Paris Descartes, Sorbonne Paris Cité, France
| | | | - Raphaele Nove-Josserand
- Adult CF centre, Hospices Civils de Lyon, Groupe hospitalier Sud, Université de Lyon, France
| | - Isabelle Pin
- Pédiatrie, Pole Couple Enfants, CHU de Grenoble; INSERM U 823, Institut Albert Bonniot, Université Joseph Fournier, Grenoble, France
| | | | - Raphael Chiron
- CF centre, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Laure Couderc
- Department of Pneumology, Rouen University Hospital, France
| | | | | | - Bertrand Delaisi
- Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paediatric Gastroenterology and Respiratory Department, CF Centre, Université Paris 7, France
| | | | - Isabelle Durieu
- Adult CF centre, Hospices Civils de Lyon, Groupe hospitalier Sud, Université de Lyon, France
| | | | - Michael Fayon
- CF centre, Hopital Pellegrin CIC 005, CHU Bordeaux, France
| | - Michèle Gérardin
- Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paediatric Gastroenterology and Respiratory Department, CF Centre, Université Paris 7, France
| | | | | | | | | | - Frédéric Huet
- CF centre, Hôpital d'enfants du Bocage, Dijon, France
| | - Muriel Le Bourgeois
- Assistance publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, CF centre, University Paris 5, France
| | | | | | | | - Isabelle Sermet-Gaudelus
- Assistance publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, CF centre, University Paris 5, France
| | | | - Stéphanie Wanin
- Hospices Civils de Lyon, Hopital Femme-Mère-Enfant, CF centre, Bron, France
| | | | - Marie-Francoise Hurtaud
- Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Biological Hematology Department, Université Paris 7, France
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Abstract
PURPOSE OF REVIEW This review discusses the current impact of pulmonary hypertension on the outcome and treatment of cystic fibrosis (CF). RECENT FINDINGS Pulmonary hypertension is commonly encountered in advanced lung diseases such as CF. The prevalence of pulmonary hypertension in CF patients varies based on disease severity and methodology used for diagnosis. Chronic alveolar hypoxia is the most likely cause. The majority of recent studies have shown worse survival in CF patients who develop pulmonary hypertension. The impact of pulmonary hypertension-specific therapies on symptomatology and outcomes in CF patients has not been well studied. SUMMARY Pulmonary hypertension is common in patients with CF and it occurs largely because of hypoxemia. The presence of pulmonary hypertension in patients with CF is likely associated with worse outcome; however, it remains unknown whether treatment with pulmonary hypertension-specific therapies would be beneficial.
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Kandamany N, Elnazir B, Greally P. Increased vigilance needed for the detection of thrombotic complications of central venous access in adolescent cystic fibrosis patients. Front Pediatr 2014; 2:117. [PMID: 25478551 PMCID: PMC4237125 DOI: 10.3389/fped.2014.00117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/13/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nandini Kandamany
- Paediatric Cystic Fibrosis Department, Adelaide and Meath National Children's Hospital, Tallaght , Dublin , Ireland
| | - Basil Elnazir
- Paediatric Cystic Fibrosis Department, Adelaide and Meath National Children's Hospital, Tallaght , Dublin , Ireland
| | - Peter Greally
- Paediatric Cystic Fibrosis Department, Adelaide and Meath National Children's Hospital, Tallaght , Dublin , Ireland
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Abstract
Venous thromboembolism (VTE) is common in patients with sickle cell disease (SCD). The etiology of increased risk of VTE in SCD patients is multifactorial and is related to both traditional factors and SCD-specific factors. Traditional risk factors such as central venous catheters, frequent hospitalization, orthopedic surgeries for avascular necrosis, and pregnancy may lead to increased incidence of VTE in the SCD population. In addition, SCD itself appears to be a hypercoagulable state, and many SCD-specific factors such as thrombophilic defects, genotype and splenectomy may modify the risk of VTE. SCD complications such as acute chest syndrome and pulmonary hypertension may also be related to VTE. Anticoagulation experts should be aware of these factors to help inform prophylaxis and treatment decisions.
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Affiliation(s)
- Rakhi P Naik
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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