Management of Extremity Venous Thrombosis in Neonates and Infants: An Experience From a Resource Challenged Setting.

Autor: Mousa A; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt.; 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Zakaria OM; 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.; 3 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt., Hanbal I; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., Nasr MA; 4 Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt., Sultan TA; 5 Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt., El-Hamid MA; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., El-Gibaly AM; 6 Department of General, Visceral, Thoracic and Vascular Surgery, Hanse Klinikum Stralsund, University Medicine of Greifswald, Stralsund, Germany., Al-Arfaj H; 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Daha AS; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., Buhalim MA; 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Zakaria MY; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., Metwally DEE; 7 Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt., Bosat BE; 8 Department of General Surgery, Al-Zahraa University Hospital, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt., Sharabi A; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., Nienaa M; 2 Divisions of Vascular Surgery, Pediatric Surgery, General Surgery, Emergency Medicine; Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia., Amin MM; 1 Department of Vascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt., Rashed KA; 9 Department of Pediatrics, Al-Hussain University Hospital, Faculty of Medicine for Male, Al-Azhar University, Cairo, Egypt.
Jazyk: angličtina
Zdroj: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis [Clin Appl Thromb Hemost] 2019 Jan-Dec; Vol. 25, pp. 1076029618814353. Date of Electronic Publication: 2018 Dec 06.
DOI: 10.1177/1076029618814353
Abstrakt: We aimed to evaluate the outcome of different treatment modalities for extremity venous thrombosis (VT) in neonates and infants, highlighting the current debate on their best tool of management. This retrospective study took place over a 9-year period from January 2009 to December 2017. All treated patients were referred to the vascular and pediatric surgery departments from the neonatal intensive care unit. All patients underwent a thorough history-taking as well as general clinical and local examination of the affected limb. Patients were divided into 2 groups: group I included those who underwent a conservative treated with the sole administration of unfractionated heparin (UFH), whereas group II included those who were treated with UFH plus warfarin. Sixty-three patients were included in this study. They were 36 males and 27 females. Their age ranged from 3 to 302 days. Forty-one (65%) patients had VT in the upper limb, whereas the remaining 22 (35%) had lower extremity VT. The success rate of the nonsurgical treatment was accomplished in 81% of patients. The remaining 19% underwent limb severing, due to established gangrene. The Kaplan-Meier survival method revealed a highly significant increase in both mean and median survival times in those groups treated with heparin and warfarin compared to heparin-only group ( P < .001). Nonoperative treatment with anticoagulation or observation (ie, wait-and-see policy) alone may be an easily applicable, effective, and a safe modality for management of VT in neonates and infants, especially in developing countries with poor or highly challenged resource settings.
Databáze: MEDLINE