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. 2019 Jan-Dec:25:1076029618814353.
doi: 10.1177/1076029618814353. Epub 2018 Dec 6.

Management of Extremity Venous Thrombosis in Neonates and Infants: An Experience From a Resource Challenged Setting

Ahmed Mousa  1   2 , Ossama M Zakaria  2   3 , Ibrahim Hanbal  1 , Mohammed A Nasr  4 , Tamer A Sultan  5 , Mohamed Abd El-Hamid  1 , Amr M El-Gibaly  6 , Haytham Al-Arfaj  2 , Ahmed S Daha  1 , Mohammed A Buhalim  2 , Mohamed Y Zakaria  1 , Dina E El Metwally  7 , Bosat E Bosat  8 , Alaa Sharabi  1 , Mohamed Nienaa  2 , Mahsoub M Amin  1 , Khaled A Rashed  9
Affiliations

Management of Extremity Venous Thrombosis in Neonates and Infants: An Experience From a Resource Challenged Setting

Ahmed Mousa et al. Clin Appl Thromb Hemost. 2019 Jan-Dec.

Abstract

We aimed to evaluate the outcome of different treatment modalities for extremity venous thrombosis (VT) in neonates and infants, highlighting the current debate on their best tool of management. This retrospective study took place over a 9-year period from January 2009 to December 2017. All treated patients were referred to the vascular and pediatric surgery departments from the neonatal intensive care unit. All patients underwent a thorough history-taking as well as general clinical and local examination of the affected limb. Patients were divided into 2 groups: group I included those who underwent a conservative treated with the sole administration of unfractionated heparin (UFH), whereas group II included those who were treated with UFH plus warfarin. Sixty-three patients were included in this study. They were 36 males and 27 females. Their age ranged from 3 to 302 days. Forty-one (65%) patients had VT in the upper limb, whereas the remaining 22 (35%) had lower extremity VT. The success rate of the nonsurgical treatment was accomplished in 81% of patients. The remaining 19% underwent limb severing, due to established gangrene. The Kaplan-Meier survival method revealed a highly significant increase in both mean and median survival times in those groups treated with heparin and warfarin compared to heparin-only group ( P < .001). Nonoperative treatment with anticoagulation or observation (ie, wait-and-see policy) alone may be an easily applicable, effective, and a safe modality for management of VT in neonates and infants, especially in developing countries with poor or highly challenged resource settings.

Keywords: anticoagulants; heparins; pediatric thrombosis; thrombosis; venous thromboembolism.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Gangrene of the right hand and right forearm.
Figure 2.
Figure 2.
Gangrene of the left foot and left leg.
Figure 3.
Figure 3.
Patients treated conservatively and those undergoing amputation.
Figure 4.
Figure 4.
Survival curve for the 2 studied groups using the Kaplan-Meier method.
See this image and copyright information in PMC

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