Journal
BEST PRACTICE & RESEARCH CLINICAL HAEMATOLOGY
Volume 22, Issue 1, Pages 103-114Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.beha.2009.01.003
Keywords
venous thromboembolism; stroke; asparaginase; prednisone; thrombophilia; central venous line; antithrombin; LMWH
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Acute lymphoblastic leukaemia (ALL) is the most common malignancy associated with venous thromboembolism (VTE) in children. The prevalence of symptomatic VTE ranges from 0% to 36%, and the variation can be explained, at least in part, by differences in chemotherapeutic protocols. The mechanism for increased risk of VTE is associated with alterations in the haemostatic system by use of L-asparaginase (ASP) alone or in combination with vincristine or prednisone, presence of central venous lines (CVLs) and/or inherited thrombophilia. The children at greatest risk are generally those receiving Escherichia coli ASP concomitant with prednisone. The majority of symptomatic VTEs Occur in the central nervous system OF in the upper venous system. In the majority Of cases, asymptomatic VTEs are associated with CVLs. External CVLs are affected more often than internal CVLs. Evidence-based guidelines on prevention and treatment guidelines for ALL-related WE are lacking, and carefully designed clinical trials are needed urgently. (c) 2009 Elsevier Ltd. All rights reserved.
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