RESUMO
BACKGROUND: Major burns are associated with multiple risk factors for thrombosis such as decreased mobilization and systemic inflammation. It is unclear if these factors are offset by the inherent lower thrombosis risk in the paediatric patient. As such there is no consensus on thromboprophylaxis for paediatric burns patients, in contrast to this being a mainstay of treatment in the adult population. This retrospective cohort study examines the incidence of, and risk factors for, thrombotic events in major paediatric burns with a view to establish guidelines for prevention. METHOD: Review of major paediatric burns, defined as % total body surface area (%TBSA) ≥30%, at the Adelaide Women's and Children's Hospital (WCH) over a 16-year period. Coding data and the local burns database were used to identify participants with subsequent review of case files. RESULTS: Of the cohort (n = 23), six cases (26%) were complicated by thrombotic events. These patients had the most extensive burns averaging 68.5% TBSA, longer PICU admissions and associated interventions. These data points were more than doubled in the cohort diagnosed with a thrombus. Of the six events, five were secondary to central venous catheters (CVC) and one deep venous thrombosis (DVT) to the left calf. CONCLUSION: The incidence of thrombotic events in our study was significant albeit in a small population. There is a strong association between large %TBSA and thrombus, with clots mostly forming around CVCs. While further research is required, this study demonstrates screening and targeted thromboprophylaxis may be required for major paediatric burns.
Assuntos
Queimaduras , Trombose , Tromboembolia Venosa , Trombose Venosa , Adulto , Criança , Humanos , Feminino , Estudos Retrospectivos , Anticoagulantes/uso terapêutico , Trombose Venosa/etiologia , Incidência , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Trombose/etiologia , Trombose/complicações , Queimaduras/complicações , Queimaduras/epidemiologia , Queimaduras/terapiaRESUMO
BACKGROUND: Anthracycline (A) and trastuzumab (T) chemotherapy have well-recognized cardiac toxicity, potentially leading to significant morbidity and mortality. Our previous work in 46 prospectively enrolled breast cancer patients showed early left ventricular (LV) and right ventricular (RV) function decline at 1 and 3â¯months, but only persistent RV dysfunction at 12â¯months which correlated with myocardial oedema observed early (1 and 3â¯months) after administration of chemotherapy regimes. METHOD: To investigate late cardiac effects, the same cohort were re-imaged with advanced Cardiovascular Magnetic Resonance (CMR) imaging including T1 mapping 5⯱â¯1â¯year post chemotherapy. RESULTS: Twenty-six out of 46 (50%) patients underwent follow-up imaging. A statistical but non-clinically significant decrease was observed in LV ejection fraction (EF) from baseline to 5â¯years (72.2⯱â¯6.6 to 65.4⯱â¯9.3, pâ¯<â¯0.005). Subjects with initial drop of LVEF by >10% at 3â¯months (nâ¯=â¯5) or at 12â¯months (nâ¯=â¯3) did not demonstrate any difference in LV or RVEF at 5â¯years. No correlation was observed between myocardial oedema and LV or RVEF at 5â¯years. At 5â¯years, T1 values were within normal limits overall (935⯱â¯48â¯ms). One patients had significantly elevated (>1000â¯ms) T1 values with no correlation to LV or RVEF. No subjects demonstrated replacement myocardial fibrosis at 5â¯years. CONCLUSION: Using advanced CMR, contemporary chemotherapy regimes demonstrate minimal long-term cardiac toxicity. There is minimal diffuse and no replacement fibrosis as demonstrated by LGE, following chemotherapy. This study suggests limiting serial imaging in these patients at 12â¯months post chemotherapy.