Thrombolytic Therapy for Venous Thromboembolism in the Pediatric Population: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: VTE in pediatric patients is usually managed with anticoagulation (AC), however, thrombolytic therapy may be necessary to rapidly restore venous patency in cases of life- or limb-threatening VTEs. The available evidence on the benefits and outcomes of thrombolysis in pediatric VTE is limited. We performed a systematic review and meta-analysis of the literature to evaluate the outcomes of thrombolytic therapy in pediatric patients with VTE. Methods: As part of the American Society of Hematology/International Society on Thrombosis and Haemostasis guidelines on the management of VTE, we searched the published literature in PubMed, Embase, and The Cochrane Central Register of Controlled Trials, from inception till February 2024. Two reviewers independently screened the studies to assess their eligibility using Covidence systematic review software (Australia). A study was included if it addressed thrombolytic therapy outcomes in pediatric patients (<21 years old) with VTE. We statistically pooled estimates using Review Manager (5.4) using a random effect model. Reviewers assessed the risk of bias using Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: After screening 8925 references, we found a total of 9 eligible studies: 2 for submassive pulmonary embolism (PE) (n=31), 3 for massive PE (n=35), and 5 for deep vein thrombosis (DVT, n=108).When comparing thrombolytic therapy to standard AC in patients with submassive PE,thrombolytic therapy might decrease the risk of progression from submassive to massive PE with an absolute risk (95% confidence interval [CI]) of 40 fewer per 1,000 (from 106 fewer to 892 more). Thrombolysis has no effect on the rates of thrombus resolution with an absolute risk (95% CI) of 0 per 1,000 (from 360 fewer to 560 more). There were no events of chronic pulmonary hypertension or bleeding in either group. Out of 19 patients, there was one death in the standard AC group compared to 0 out of 14 in the thrombolysis group.In patients with massive PE, thrombolytic therapy may decrease mortality rates with an absolute risk (95% CI) of 60 fewer per 1,000 (from 290 fewer to 425 more) and may increase the risk of thrombosis recurrence with an absolute risk (95% CI) of 228 more per 1000 (from 86 fewer to 1000 more). Bleeding was not estimable with 1 event out of 7 patients in the thrombolysis group versus no bleeding on 1 patient in the standard AC group. In patients with DVT, when compared to standard AC, thrombolytic therapy has little to no effect on mortality, recurrence of thrombosis, and major bleeding with an absolute risk (95% CI) of 3 fewer per 1,000 (from 76 fewer to 346 more), 3 fewer per 1,000 (from 76 fewer to 346 more), and 22 fewer per 1,000 (from 82 fewer to 444 more), respectively. For CRNMB, 1 event out of 42 occurred in the AC group. Thrombolytic therapy might increase the rate of thrombus resolution, and risk of PTS when compared to standard AC, with an absolute risk (95% CI) of 200 more per 1,000 (from 7 fewer to 469 more), and 333 more per 1,000 (from 88 fewer to 1,000 more), respectively. The certainty of evidence for all estimates is very low due to concerns related to risk of bias and imprecision because of the small number of patients. Conclusion:The certainty of the evidence is very low (very small sample size and high risk of bias) which limits our ability to make definitive conclusions on the benefits and short-term and long-term outcomes of thrombolysis in children.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,035 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,020 | 0,035 |
| Bibliométrie | 0,007 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».