Treatment of chronic venous diseases in children and adolescents

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life

Diagnosis and treatment of deep vein thrombosis in neonates and nurselings

The authors share herein their experience in diagnosis and treatment of deep vein thrombosis in neonates and nurselings. We examined a total of 132 infants undergoing treatment in an intensive care unit. Of these, 15 infants were diagnosed with various-localization thromboses. Ultrasonographic study was the main method of diagnosis. Management consisted in anticoagulant therapy. Timely administration of anticoagulant therapy made it possible to achieve complete recanalization of venous lumens in 80% of cases. Only 20% of infants were found to have vein occlusion preserved, thus requiring further follow up and treatment. Neither complications nor relapsing thromboses were observed. A conclusion was drawn that characteristic of neonates and infants under 12 months of life is a specific profile of etiopathogenesis of deep vein thrombosis. In the majority of cases thrombosis appears to be catheter-related, and only in sporadic cases it forms spontaneously. Treatment of thromboses is typically associated with high successfulness of medicamentous therapy

Safety of dabigatran etexilate for the secondary prevention of venous thromboembolism in children

This open-label, single-arm, prospective cohort trial is the first phase 3 safety study to describe outcomes in children treated with dabigatran etexilate for secondary venous thromboembolism (VTE) prevention. Eligible children aged 12 to <18 years (age stratum 1), 2 to <12 years (stratum 2), and >3 months to <2 years (stratum 3) had an objectively confirmed diagnosis of VTE treated with standard of care (SOC) for ‡3 months, or had completed dabigatran or SOC treatment in the DIVERSITY trial (NCT01895777) and had an unresolved clinical thrombosis risk factor requiring further anticoagulation. Children received dabigatran for up to 12 months, or less if the identified VTE clinical risk factor resolved. Primary end points included VTE recurrence, bleeding events, and mortality at 6 and 12 months. Overall, 203 children received dabigatran, with median exposure being 36.3 weeks (range, 0-57 weeks); 171 of 203 (84.2%) and 32 of 203 (15.8%) took capsules and pellets, respectively. Overall, 2 of 203 children (1.0%) experienced on-treatment VTE recurrence, and 3 of 203 (1.5%) experienced major bleeding events, with 2 (1.0%) reporting clinically relevant nonmajor bleeding events, and 37 (18.2%) minor bleeding events. There were no on-treatment deaths. On-treatment postthrombotic syndrome was reported for 2 of 162 children (1.2%) who had deep vein thrombosis or central-line thrombosis as their most recent VTE. Pharmacokinetic/pharmacodynamic relationships of dabigatran were similar to those in adult VTE patients. In summary, dabigatran showed a favorable safety profile for secondary VTE prevention in children aged from >3 months to <18 years with persistent VTE risk factor(s). This trial was registered at www.clinicaltrials.gov as #NCT02197416. (Blood. 2020;135(7):491-504

Rivaroxaban Compared with Standard Anticoagulants for the Treatment of Acute Venous Thromboembolism in Children: a Randomised, Controlled, Phase 3 Trial

Background: Treatment of venous thromboembolism in children is based on data obtained in adults with little direct documentation of its efficacy and safety in children. The aim of our study was to compare the efficacy and safety of rivaroxaban versus standard anticoagulants in children with venous thromboembolism. Methods: In a multicentre, parallel-group, open-label, randomised study, children (aged 0–17 years) attending 107 paediatric hospitals in 28 countries with documented acute venous thromboembolism who had started heparinisation were assigned (2:1) to bodyweight-adjusted rivaroxaban (tablets or suspension) in a 20-mg equivalent dose or standard anticoagulants (heparin or switched to vitamin K antagonist). Randomisation was stratified by age and venous thromboembolism site. The main treatment period was 3 months (1 month in children <2 years of age with catheter-related venous thromboembolism). The primary efficacy outcome, symptomatic recurrent venous thromboembolism (assessed by intention-to-treat), and the principal safety outcome, major or clinically relevant non-major bleeding (assessed in participants who received ≥1 dose), were centrally assessed by investigators who were unaware of treatment assignment. Repeat imaging was obtained at the end of the main treatment period and compared with baseline imaging tests. This trial is registered with ClinicalTrials.gov, number NCT02234843 and has been completed. Findings: From Nov 14, 2014, to Sept 28, 2018, 500 (96%) of the 520 children screened for eligibility were enrolled. After a median follow-up of 91 days (IQR 87–95) in children who had a study treatment period of 3 months (n=463) and 31 days (IQR 29–35) in children who had a study treatment period of 1 month (n=37), symptomatic recurrent venous thromboembolism occurred in four (1%) of 335 children receiving rivaroxaban and five (3%) of 165 receiving standard anticoagulants (hazard ratio [HR] 0·40, 95% CI 0·11–1·41). Repeat imaging showed an improved effect of rivaroxaban on thrombotic burden as compared with standard anticoagulants (p=0·012). Major or clinically relevant non-major bleeding in participants who received ≥1 dose occurred in ten (3%) of 329 children (all non-major) receiving rivaroxaban and in three (2%) of 162 children (two major and one non-major) receiving standard anticoagulants (HR 1·58, 95% CI 0·51–6·27). Absolute and relative efficacy and safety estimates of rivaroxaban versus standard anticoagulation estimates were similar to those in rivaroxaban studies in adults. There were no treatment-related deaths. Interpretation: In children with acute venous thromboembolism, treatment with rivaroxaban resulted in a similarly low recurrence risk and reduced thrombotic burden without increased bleeding, as compared with standard anticoagulants. Funding: Bayer AG and Janssen Research & Development. © 2020 Elsevier Ltd

Treatment of chronic venous diseases in children and adolescents

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life

Remote diagnostics and treatment tactics for complex congenital heart defects in newborns

Complex congenital heart defects in newborns require the development of therapeutic tactics in a short time. It is often impossible for the patient to visit a cardiologist or cardiac surgeon due to the remoteness.Objective: to describe the principles of the algorithm for remote diagnostics and treatment tactics of newborns with complex congenital heart defects.The article presents the features of the course of heart disease in newborns, taking into account the specificity of hemodynamics. The authors describe the diagnostic principles using remote consultation of the patient. The authors developed a scale to choose therapeutic tactics by the specific group of the identified heart disease.Conclusions: 1. Remote consultation on the diagnosis and treatment tactics of patients with congenital heart defects is highly relevant for regions with a low population density; 2. Remote contactless consultation is particularly important during periods of emergency and epidemics

Diagnosis and treatment of deep vein thrombosis in neonates and nurselings

The authors share herein their experience in diagnosis and treatment of deep vein thrombosis in neonates and nurselings. We examined a total of 132 infants undergoing treatment in an intensive care unit. Of these, 15 infants were diagnosed with various-localization thromboses. Ultrasonographic study was the main method of diagnosis. Management consisted in anticoagulant therapy. Timely administration of anticoagulant therapy made it possible to achieve complete recanalization of venous lumens in 80% of cases. Only 20% of infants were found to have vein occlusion preserved, thus requiring further follow up and treatment. Neither complications nor relapsing thromboses were observed. A conclusion was drawn that characteristic of neonates and infants under 12 months of life is a specific profile of etiopathogenesis of deep vein thrombosis. In the majority of cases thrombosis appears to be catheter-related, and only in sporadic cases it forms spontaneously. Treatment of thromboses is typically associated with high successfulness of medicamentous therapy

Treatment of chronic venous diseases in children and adolescents

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life

Treatment of chronic venous diseases in children and adolescents

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life

Diagnosis and treatment of deep vein thrombosis in neonates and nurselings

The authors share herein their experience in diagnosis and treatment of deep vein thrombosis in neonates and nurselings. We examined a total of 132 infants undergoing treatment in an intensive care unit. Of these, 15 infants were diagnosed with various-localization thromboses. Ultrasonographic study was the main method of diagnosis. Management consisted in anticoagulant therapy. Timely administration of anticoagulant therapy made it possible to achieve complete recanalization of venous lumens in 80% of cases. Only 20% of infants were found to have vein occlusion preserved, thus requiring further follow up and treatment. Neither complications nor relapsing thromboses were observed. A conclusion was drawn that characteristic of neonates and infants under 12 months of life is a specific profile of etiopathogenesis of deep vein thrombosis. In the majority of cases thrombosis appears to be catheter-related, and only in sporadic cases it forms spontaneously. Treatment of thromboses is typically associated with high successfulness of medicamentous therapy