Acute prognostic factors for post-thrombotic syndrome in children with limb DVT: a bi-institutional cohort study.

Background: Early identification of children with deep venous thrombosis (DVT) of the limb who are at heightened risk for post-thrombotic syndrome (PTS) is important in order to evaluate therapeutic interventions aimed at decreasing the risk and severity of PTS.

Objective: We sought to evaluate acute prognostic factors for PTS in children following DVT of the limbs.

Materials And Methods: In this bi-institutional mixed cohort study with prospective ascertainment of PTS using a validated pediatric instrument, we collected data on patient/thrombus characteristics, thrombophilia testing results, and outcomes in children (<21years at event) diagnosed with acute limb DVT at Rady Children's Hospital of San Diego and Children's Hospital Colorado.

A male adolescent with left iliac thrombophlebitis and heterozygosity for factor V Leiden mutation.

The epidemiology of deep vein thrombosis in adolescents has 2 potential associations. First, there is a demonstrated association with a congenital anomaly of the inferior vena cava (Dean SM, Tytle TL. Vas Med.

Recombinant activated factor VII effectively reverses the anticoagulant effects of heparin, enoxaparin, fondaparinux, argatroban, and bivalirudin ex vivo as measured using thromboelastography.

Bleeding is the major adverse reaction to anticoagulants, leading to significant morbidity and even mortality. Protamine is a specific antidote for heparin yet is only partially effective for enoxaparin, and the activated factor X inhibitor fondaparinux and the direct thrombin inhibitors argatroban and bivalirudin lack specific antidotes. We evaluated the ability of recombinant activated factor VII (rFVIIa), a general hemostatic agent, to reverse the anticoagulant effects of heparin, enoxaparin, fondaparinux, argatroban, and bivalirudin, as measured by thromboelastography.

Differential effects of direct thrombin inhibitors and antithrombin-dependent anticoagulants on the dynamics of clot formation.

New anticoagulants, including the direct thrombin inhibitors (DTIs) and fondaparinux, are increasingly replacing unfractionated heparin and enoxaparin. We examined the effects of argatroban (n = 60), bivalirudin (n = 44), heparin (n = 14), enoxaparin (n = 22), and fondaparinux (n = 24) on clot formation utilizing thromboelastography. Blood samples containing anticoagulants at clinically relevant concentrations were prepared ex vivo and analyzed using kaolin or tissue factor activation.

Safety and pharmacokinetics of recombinant factor XIII-A2 administration in patients with congenital factor XIII deficiency.

Congenital factor XIII (FXIII) deficiency is associated with a tendency for severe bleeding, a risk for spontaneous abortion, and a high rate of spontaneous intracranial hemorrhage. This phase 1 escalating-dose study was developed to evaluate the safety and pharmacokinetics of a single administration of human recombinant FXIII-A2 (rFXIII-A2) homodimer in adults with congenital FXIII deficiency. Pharmacokinetics and activity of rXIII and changes in endogenous B subunit levels were assessed.