4 results on '"Macartney, Christine"'
Search Results
2. Strategies to Prevent and Manage Thrombotic Complications of Acute Lymphoblastic Leukemia in Children and Young People Vary Between Centers in the United Kingdom.
- Author
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Biss TT, Payne JH, Hough RE, Grainger JD, Macartney C, Sibson KR, and Chalmers EA
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Child, Child, Preschool, Female, Humans, Infant, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Surveys and Questionnaires, United Kingdom, Young Adult, Medical Oncology standards, Practice Patterns, Physicians' standards, Precursor Cell Lymphoblastic Leukemia-Lymphoma complications, Thrombosis prevention & control
- Abstract
There is a lack of evidence-based guidance for the prevention and management of thrombosis in children and young people treated for acute lymphoblastic leukemia. To determine current UK practice, a survey was sent to 28 centers participating in the Medical Research Council UKALL 2011 trial. Marked variation in practice was noted. In total, 43% of centers defer central venous access device insertion until end of induction for treatment of low-risk disease. Central venous access devices are removed at the end of intensive blocks in 38% and end of treatment in 42%. Duration of anticoagulation for line-associated thrombosis is 6 weeks in 43% and 3 months in 33% and for cerebral sinovenous thrombosis is 3 months in 71% and 6 months in 24%. Platelet transfusion to maintain platelet count >50×10/L, in preference to interrupting therapeutic anticoagulation, is used by 50% for line-associated thrombosis and 73% for cerebral sinovenous thrombosis. Conformity of practice was seen in some areas. In total, 70% treat thrombosis with twice-daily low-molecular weight heparin and 86% monitor antifactor Xa activity levels. In total, 91% reexpose individuals to asparaginase following a thrombotic event. Given this variation in practice, in the absence of high-quality evidence, consensus guidelines may be helpful.
- Published
- 2016
- Full Text
- View/download PDF
3. Assessment of the outcomes associated with periprocedural anticoagulation management in children with acute lymphoblastic leukemia.
- Author
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Avila ML, Macartney CA, Hitzler JK, Williams S, Kiss A, and Brandão LR
- Subjects
- Adolescent, Anticoagulants therapeutic use, Child, Child, Preschool, Clinical Protocols, Disease Progression, Drug Administration Schedule, Female, Follow-Up Studies, Hematoma prevention & control, Heparin adverse effects, Heparin therapeutic use, Heparin, Low-Molecular-Weight adverse effects, Heparin, Low-Molecular-Weight therapeutic use, Humans, Infant, Logistic Models, Male, Multivariate Analysis, Postoperative Complications prevention & control, Precursor Cell Lymphoblastic Leukemia-Lymphoma surgery, Preoperative Care methods, Recurrence, Retrospective Studies, Risk Factors, Spinal Diseases prevention & control, Thrombosis etiology, Thrombosis prevention & control, Treatment Outcome, Anticoagulants adverse effects, Hematoma chemically induced, Postoperative Complications chemically induced, Precursor Cell Lymphoblastic Leukemia-Lymphoma complications, Spinal Diseases chemically induced, Spinal Puncture, Thrombosis drug therapy
- Abstract
Objective: To report the outcomes of an institutional protocol for periprocedural anticoagulant (AC) management in children with acute lymphoblastic leukemia (ALL)., Study Design: Children being treated for ALL who received full-dose (therapeutic) anticoagulation before undergoing at least 1 lumbar puncture (LP) were included in this retrospective cohort study. The main outcome was the risk of traumatic LP; exploratory analysis included the risks of symptomatic spinal hematoma and progression/recurrence of the thrombotic event. Analyses were conducted using logistic regression analysis with a generalized estimating equation approach., Results: Twenty-two children with ALL receiving an AC underwent a total of 396 LPs. Although traumatic LP was associated with full-dose AC therapy in univariable analysis, a multiple logistic regression model controlling for other risk factors for traumatic LP showed that AC therapy was not significantly associated with the risk of traumatic LP when the ACs were held as per the institutional protocol. No patient developed symptomatic spinal hematoma. Exploratory analysis revealed that AC dose, a likely marker of thrombus burden, was significantly associated with progression/recurrence of the thrombotic event in univariable analysis., Conclusion: In our cohort, recent AC therapy was not statistically associated with an increased risk of bleeding after LP when following a specific protocol for periprocedural AC management. The risk associated with the progression/recurrence of thromboembolic events requires further evaluation., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
4. Thrombosis in children.
- Author
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Macartney CA and Chan AK
- Subjects
- Adolescent, Catheterization, Central Venous adverse effects, Child, Child, Preschool, Factor V genetics, Fibrinolytic Agents therapeutic use, Hemostasis, Heparin adverse effects, Heparin therapeutic use, Humans, Iliac Vein abnormalities, Infant, Prothrombin genetics, Pulmonary Embolism diagnosis, Thrombosis complications, Thrombosis epidemiology, Thrombosis therapy, Venous Thrombosis diagnosis, Venous Thrombosis genetics, Vitamin K antagonists & inhibitors, Warfarin therapeutic use, Anticoagulants therapeutic use, Thrombosis diagnosis
- Abstract
Thrombosis in children is becoming more prevalent due to increased awareness of these issues in the pediatric population and advances in medicine. Management of affected children are challenging due to differences in their hemostatic system compared with adults. Prospective, controlled trials for management/treatment of children with thrombosis are lacking. Many of the available guidelines for treatment of thrombosis in children are extrapolated from adult data and do not account for the uniqueness of the pediatric hemostatic system, although more research and data are becoming available. This review will focus on children over 1 year of age, including adolescents, looking at the etiology of thrombosis, diagnosis, management options, and any associated complications in this pediatric population., (© Thieme Medical Publishers.)
- Published
- 2011
- Full Text
- View/download PDF
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