TY - JOUR
T1 - Hemostatic and thrombotic disorders in the pediatric patient
AU - O'Brien, Sarah H.
AU - Zia, Ayesha
N1 - Funding Information:
Conflict-of interest disclosure: S.H.O. serves as study chair for a clinical trial by the Children's Oncology Group (COG) of apixaban, a direct oral anticoagulant. For this work, S.H.O.'s institution has received salary support from COG, and S.H.O. has received travel reimbursement from COG and advisory board honoraria from Bristol Myers Squibb. A.Z. has received honoraria from Takeda in an advisory capacity.
Funding Information:
A.Z. is supported by grants from the National Institutes of Health, National Heart, Lung, and Blood Institute grants 1K23HL132054-01 and 1R56HL153963-01 and American Heart Association (20IPA35320263). The funding sources were not involved in the writing of the report or the decision to submit the article for publication.
Publisher Copyright:
© 2022 American Society of Hematology
PY - 2022/8/11
Y1 - 2022/8/11
N2 - This review focuses on significant advances in the field of pediatric hemostasis and thrombosis, with a focus on published studies within the past decade. The evaluation and management of patients with excessive bleeding remain cornerstones of consultative hematology. We will describe the development of validated bleeding assessment tools relevant to pediatric practice, laboratory advances in the evaluation of von Willebrand disease, and a shift in clinical practice regarding the interpretation of normal coagulation studies in patients with significant bleeding phenotypes. There have also been critical advances in the management of hemostatic disorders. This review highlights new treatment paradigms in hemophilia and the rise of multidisciplinary medical homes for women living with bleeding disorders. Given the continued increase in the incidence of thrombosis, particularly in the hospital setting, a full call to arms against pediatric venous thromboembolism is now essential. We will describe recently completed clinical trials of direct oral anticoagulants in children and adolescents and ongoing work to elucidate the appropriate duration of therapy for children with provoked thrombosis. Recent work regarding the prevention of pediatric venous thromboembolism is highlighted, including studies of thromboprophylaxis and the development of risk prediction models for hospital-acquired thrombosis. Finally, we review advances in our understanding of thrombotic sequelae and the need for continued refinement of our evaluation tools. Despite the significant advances in pediatric hemostasis and thrombosis over the past decade, many unanswered questions remain for the next generation of investigators.
AB - This review focuses on significant advances in the field of pediatric hemostasis and thrombosis, with a focus on published studies within the past decade. The evaluation and management of patients with excessive bleeding remain cornerstones of consultative hematology. We will describe the development of validated bleeding assessment tools relevant to pediatric practice, laboratory advances in the evaluation of von Willebrand disease, and a shift in clinical practice regarding the interpretation of normal coagulation studies in patients with significant bleeding phenotypes. There have also been critical advances in the management of hemostatic disorders. This review highlights new treatment paradigms in hemophilia and the rise of multidisciplinary medical homes for women living with bleeding disorders. Given the continued increase in the incidence of thrombosis, particularly in the hospital setting, a full call to arms against pediatric venous thromboembolism is now essential. We will describe recently completed clinical trials of direct oral anticoagulants in children and adolescents and ongoing work to elucidate the appropriate duration of therapy for children with provoked thrombosis. Recent work regarding the prevention of pediatric venous thromboembolism is highlighted, including studies of thromboprophylaxis and the development of risk prediction models for hospital-acquired thrombosis. Finally, we review advances in our understanding of thrombotic sequelae and the need for continued refinement of our evaluation tools. Despite the significant advances in pediatric hemostasis and thrombosis over the past decade, many unanswered questions remain for the next generation of investigators.
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U2 - 10.1182/blood.2020006477
DO - 10.1182/blood.2020006477
M3 - Review article
C2 - 34724564
AN - SCOPUS:85130072444
SN - 0006-4971
VL - 140
SP - 533
EP - 541
JO - Blood
JF - Blood
IS - 6
ER -