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Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children

Lookup NU author(s): Dr Tina Biss

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Abstract

© 2019. Introduction: The incidence of thromboembolic (TE)-pediatric pulmonary embolism (PPE) is increasing. We sought to evaluate current practice patterns and gaps in the management of TE-PPE. Materials and methods: After Institutional Review Board approval, SurveyMonkey® questions were sent to members of the Pediatric/Neonatal Thrombosis and Hemostasis Subcommittee, of the International Society on Thrombosis and Haemostasis and the Hemostasis and Thrombosis Research Society. Results: Of 442 members of the two groups, 134 (30%) responded, and 125 (28%) complete responses were analyzed. Eighty percent practiced at a pediatric facility, 88% at academic centers, and 59% in the USA. Computed tomography pulmonary angiography (CTPA) was the preferred diagnostic modality (89%). D-dimer testing was variably used; 22% used clinical diagnostic prediction models and 8% had specific clinical care pathways for TE-PPE management. Prognostic stratification models were used to guide therapy by 4%. Indications for thrombolytic therapy varied considerably; 40% had a standardized protocol for thrombolysis, employing various modalities (45% systemic, 25% catheter-directed, 19% pharmaco-mechanical) and tissue plasminogen activator dose intensities. Duration of anticoagulation was variable with 58% prescribing anticoagulation for duration of >3 months–6 months; 61% followed for long-term adverse outcomes. Conclusion: This multinational survey of thrombosis/hemostasis specialists mainly based at pediatric academic centers demonstrates that antithrombotic management of TE-PPE (including duration of anticoagulation and use/non-use of thrombolysis) varies considerably. Furthermore, standardized care pathways to facilitate acute evaluation and management decisions are in place in a minority of centers. These findings help to inform the design of future clinical trials in TE-PPE.

Publication metadata

Author(s): Rajpurkar M, Williams S, Goldenberg NA, Van Ommen CH, Chan AKC, Thomas R, Biss T

Publication type: Article

Publication status: Published

Journal: Thrombosis Research

Year: 2019

Volume: 183

Pages: 98-105

Print publication date: 01/11/2019

Online publication date: 14/08/2019

Acceptance date: 02/08/2019

ISSN (print): 0049-3848

ISSN (electronic): 1879-2472

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.thromres.2019.08.002

DOI: 10.1016/j.thromres.2019.08.002

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