Venous thromboembolism at uncommon sites in neonates and children

J Pediatr Hematol Oncol. 2014 Nov;36(8):624-9. doi: 10.1097/MPH.0000000000000116.

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.

MeSH terms

  • Anticoagulants / therapeutic use*
  • Child
  • Esophageal and Gastric Varices / pathology
  • Factor V / metabolism
  • Female
  • Follow-Up Studies
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Hypertension, Portal / pathology
  • Infant
  • Infant, Newborn
  • Male
  • Mesenteric Veins / pathology
  • Methylenetetrahydrofolate Reductase (NADPH2) / genetics
  • Portal Vein / pathology
  • Protein S Deficiency / pathology
  • Pulmonary Veins / pathology
  • Renal Veins / pathology
  • Retrospective Studies
  • Spleen / pathology
  • Veins / pathology*
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / genetics
  • Venous Thromboembolism / pathology*
  • Venous Thrombosis / drug therapy*
  • Venous Thrombosis / genetics
  • Venous Thrombosis / pathology*
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • factor V Leiden
  • Warfarin
  • Factor V
  • MTHFR protein, human
  • Methylenetetrahydrofolate Reductase (NADPH2)