ISSN: 2044-9038 (Print) 2044-9046 (Electronic)

Clinical Practice

Indexed Journals On Pediatric Hematology

 Consultation with pediatric hematology is defensible. Identified clinical activates for thrombosis should be alleviated, if possible (e.g., discontinuing estrogen-containing oral contraceptives, treating causal infectious diseases or inflammatory conditions). Conventional treatment for a first thrombotic event includes acute anticoagulation with a heparin-based agent (unfractionated heparin [UFH] or low-molecular-weight heparin [LMWH]) for approximately 1 week, followed by subacute/extended anticoagulation with LMWH or warfarin. Anticoagulation is given to decrease the risk for thrombus progression or embolism; thrombus regression is believed to rely on inherent fibrinolytic mechanisms to soften thrombosis over time. Duration of anticoagulation is risk stratified, currently based mainly on adult evidence: For VTE associated with a risk factor that has determined, recommended duration is 3 to 6 months (3 months is most often used); for idiopathic VTE, suggested duration is 6 to 12 months; for VTE stirring in the setting of a chronic prothrombotic risk factor, recommended duration is 12 months at minimum. In each of the aforesaid categories, a longer period of anticoagulation for acute VTE is suggested in patients who have had a previous thrombotic event. Indefinite conduct is often warranted in the setting of potent congenital thrombophilia (e.g., severe protein C deficiency). In antiphospholipid antibody syndrome, treatment duration is unclear and often adapted. Anticoagulant dosing and nursing recommendations have been previously published by Monagle and colleagues. Heparin-based therapy is preferably monitored by anti–factor Xa activity level, whereas warfarin is observed via the international normalized ratio.

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