Among pediatric patients with acute lymphoblastic leukemia (ALL), there are no standardized practices for treating venous thromboembolism (VTE), according to research published in the Journal of Thrombosis and Thrombolysis.
A common issue among pediatric patients with ALL, VTE may occur in more than 1 in 3 patients. Although the causes of VTE are well established — the complication is linked with the use of central venous catheters, thrombophilia, and treatments including asparaginase — there are no standard treatment guidelines once VTE develops.
For this survey-based study, researchers attempted to identify patterns in VTE treatment and prevention in pediatric patients with ALL. The 44-item survey, which was cross sectional, anonymous, and included members of the American Society of Hematology and the pediatric subcommittee of the VTE Network US of the Hemostasis and Thrombosis Research Society, was shared with 870 practicing individuals, of whom 154 (17.7%) responded.
Overall, 76 (52%) clinicians practiced in hematology, 19 (13%) practiced in oncology, 40 (28%) worked in a combined practice, and 10 (7%) worked in a bone marrow transplant practice. Thirty-eight (26%) of the clinicians had 5 years or less of practice experience, while 44 (30%) had 16 or more, and the majority (99; 68%) saw between 0 and 50 new leukemia cases per year. All but 1 respondent practiced in the United States.
Catheter-associated deep vein thrombosis was, overall, the most common type of treated VTE. Half of respondents reported treating this variety of VTE for 3 months, while 16% reported continuing treatment until line removal. Treatment duration periods of both cerebral venous sinus thrombosis and pulmonary embolism also varied greatly in respondent reports. Whether clinicians decided to continue anticoagulation in case of thrombocytopenia was, furthermore, inconsistent.
“There is variability regarding duration of treatment of VTE events, as well as class of anticoagulants used, platelet-holding criteria for anticoagulation, and prophylaxis practices,” the authors wrote. “Given the variation in these supportive care practices, cooperative group guidelines may be a way to streamline practice and allow for the prospective study of management of VTE in children with ALL.”
Degliuomini M, Cooley V, Mauer E, Gerber LM, Acharya S, Kucine N. Assessment of provider practices regarding venous thromboembolism management and prevention in pediatric acute leukemia patients. J Thromb Thrombolysis. Published online January 24, 2021. doi:10.1007/s11239-021-02379-6