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Children with pelvic and thigh fractures develop dangerous blood clots so rarely that anti-clotting therapyshould be given only to those with underlying conditions thatincrease clotting risk, according to a study from Johns HopkinsChildren's Center. The research, to be published in the June issue of the Journal of Pediatric Orthopaedics, challenges several earlier reports that found a relatively highrisk of developing dangerous clots deep inside the veins amongpediatric patients. The new findings, the investigators say,suggest that preemptive anti-coagulant medications may be bestreserved for children whose risk of forming a clot outweighs thesmall but very real risk of bleeding associated with anti-clottingdrugs. For the study, researchers reviewed 1,782 records of pediatrictrauma patients treated at Hopkins between 1990 and 2009. Clotswere reported in three children (0.17 percent), none of whomdeveloped life-threatening complications. The investigators say they believe their research is the first toevaluate clotting risk in healthy children with pelvic and thighfractures and should help clinicians better weigh the pros and consof preemptive anti-clotting therapy. Anticoagulants have serious,if rare, side effects that include bleeding in the brain, stomachand other organs. Anticoagulants are routinely given to adult trauma patients toprevent deep-vein clotting. Between 20 and 90 percent of adulttrauma patients develop such blood clots, researchers estimate.Known as deep venous thrombosis, or DVT, such clots can travel tothe lungs and cause pulmonary embolism , a potentially fatal condition that requires emergency treatment.Previous studies have found that between 4 and 22 percent of adulttrauma patients with DVT progress to pulmonary embolism. Because of this well-established risk, guidelines call foranti-coagulant therapy in all adult trauma patients with bonefractures. But to date, scant data on clotting risk among childrenhas rendered such decisions tricky, the researchers say. "Weighing the unknown risk of blood clots against the risk ofover-treatment is like solving an equation with two unknowns, butwe hope that our findings will provide some context and clarity forpediatricians in such situations," says study lead investigatorMichael Ain, M.D., a pediatric orthopedic surgeon at HopkinsChildren's. "Because we found that clots are extremely rare in otherwisehealthy children who suffer traumatic fractures, we believe thatanti-clotting medications should be saved for those with underlyingconditions like heart disease and cancer or some inherited conditions that make the blood more prone toclotting," adds Ain. In the study, the three children with blood clots developed them intheir femoral veins and were diagnosed by ultrasound prompted bysymptoms suggestive of a blood clot. Such symptoms usually include leg pain and swelling or skin discoloration and warmth in the affected leg.Many people who develop DVT, however, have no symptoms, theresearch team cautions. All three children with DVT were treated successfully withanti-clotting medication and none experienced complications fromeither the clot or the treatment. Thirty-one of the children in thestudy died, none of them of DVT-related complications. The mostcommon causes of death were brain bleeding and brain swelling,secondary to traumatic brain injury. Although 4 percent of the children (68) in the current study had acentral venous catheter - a device believed to be the single mostimportant DVT risk factor in otherwise healthy children - none ofthe three who developed DVT had such a device, the study found.Nine percent of patients in the study received preemptiveanti-clotting therapy. There were no adverse effects among thosewho got anti-clotting medication. Researchers emphasize that the low rate of DVT in the populationthey studied likely stems from the fact that most of the childrenwere healthy and had no underlying diseases that drive up clottingrisk, such as congenital heart disease or cancer. Additional References Citations. I am an expert from meter-test-bench.com, while we provides the quality product, such as Energy Meter Testing Equipment , Reference Standard Meter Manufacturer, Electric Meter Test Equipment,and more.
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