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Role of Anticoagulation in the Management of Tumor Thrombus: A 10 year single center experience
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  • Shreya Agarwal,
  • Dolores Mullikin,
  • Valeria Smith,
  • Michael Scheurer,
  • Bindi Naik-Mathuria,
  • Paul Guillerman,
  • Jennifer Foster,
  • Rosa Diaz,
  • Sarah Sartain
Shreya Agarwal
Texas Children's Hospital
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Dolores Mullikin
Baylor College of Medicine
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Valeria Smith
Baylor College of Medicine
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Michael Scheurer
Texas Children's Hospital
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Bindi Naik-Mathuria
Texas Children's Hospital
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Paul Guillerman
Texas Children's Hospital
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Jennifer Foster
Texas Children's Hospital
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Rosa Diaz
Texas Children's Hospital
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Sarah Sartain
Baylor College of Medicine
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Abstract

Background: Children with cancer diagnosis are overall at a higher risk of thrombosis. For a newly diagnosed bland thrombus, patients are commonly started on anticoagulants to prevent further extension and embolization of the clot. In the rare instance that a pediatric patient has a tumor thrombus, the role of anticoagulation is less clear. Procedure/Methods: Patients under 21 years of age with a finding of tumor thrombus on imaging from 2010-2020 at Texas Children’s Hospital were identified and their medical records were reviewed. Results: A total of 50 patients were identified. Most thrombi were incidental findings at diagnosis; however, there were two patients who presented with pulmonary embolism (PE). Inferior Vena Cava extension was noted in 36% of the patients and 24% patients had an intracardiac tumor thrombus. Hepatoblastoma (26%) was the most common malignancy associated with tumor thrombus. Anticoagulation was initiated in 10 patients (20%). Only 2 of these 10 patients showed response to anticoagulation. However, 40% (4/10) patients in the anticoagulation cohort were noted to have bleeding complications (p <.05). Conclusion: Children with intravascular extension of solid tumors were not commonly started on anticoagulation at the time of diagnosis, irrespective of the extent of tumor thrombus. Furthermore, we observed a significant trend toward higher incidence of bleeding complications after initiation of anticoagulation. There is inadequate evidence at this time to support routine initiation of anticoagulation in pediatric patients with intravascular extension of solid tumors.

Peer review status:ACCEPTED

09 Mar 2021Submission Checks Completed
09 Mar 2021Assigned to Editor
09 Mar 2021Submitted to Pediatric Blood & Cancer
11 Mar 2021Reviewer(s) Assigned
25 Mar 2021Review(s) Completed, Editorial Evaluation Pending
26 Mar 2021Editorial Decision: Revise Major
23 Apr 20211st Revision Received
23 Apr 2021Submission Checks Completed
23 Apr 2021Assigned to Editor
26 Apr 2021Reviewer(s) Assigned
13 May 2021Review(s) Completed, Editorial Evaluation Pending
14 May 2021Editorial Decision: Accept