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Hamostaseologie 2025; 45(02): 158-165
DOI: 10.1055/a-2407-7914
Review Article

Update on Cancer-Associated Venous Thromboembolism in Children

Authors

  • Rahel Kasteler

    1   Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
    2   Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland

  • Manuela Albisetti

    1   Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland

  • Alessandra Bosch

    1   Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland

Funding Rahel Kasteler declares receiving a research grant from “SPOG Young Investigator Grant.” Alessandra Bosch declares receiving a research grant from “Claus Cramer Foundation.”
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Abstract

Children with cancer have an increased risk for venous thromboembolic events (VTEs) compared to the healthy pediatric population. VTE rates in children with cancer vary among cancer types. Other VTE risk factors include central venous catheters and cancer therapies. VTE diagnosis relies on objective radiological imaging, and management to this date typically involves anticoagulant therapy. Low-molecular-weight heparins (LMWHs) are the most common choice. Evidence for primary VTE prevention is conflicting, and antithrombin replacement, LMWH, or apixaban have been studied. Recently, direct oral anticoagulants such as rivaroxaban or dabigatran were investigated for VTE treatment, showing promise in efficacy and safety. However, bleeding risks in this population need careful consideration, especially periprocedurally or with treatment-related thrombocytopenia. Prediction tools for VTE require adaptation for pediatric cancer patients. Progress in understanding and managing VTE in children with cancer is significant, with ongoing trials and real-world data contributing to improved strategies.

Zusammenfassung

Kinder mit malignen Erkrankungen haben im Vergleich zu gesunden Kindern ein erhöhtes Risiko für venöse thromboembolische Ereignisse (VTE). Die VTE-Raten variieren je nach Krebsart. Weitere VTE-Risikofaktoren sind zentrale Venenkatheter und Chemotherapien. Die VTE-Diagnose beruht auf einer objektiven radiologischen Bildgebung, und die Behandlung umfasst in der Regel eine Antikoagulation. Niedermolekulare Heparine (LMWH) sind die häufigste Wahl. Studienergebnisse zur VTE-Prävention sind widersprüchlich. Es wurden bisher Antithrombin-Substitutionen, LMWH oder zuletzt Apixaban untersucht. In jüngster Zeit wurden direkte orale Antikoagulanzien (DOAC) wie Rivaroxaban oder Dabigatran für die VTE-Behandlung untersucht, die vielversprechend in Bezug auf Wirksamkeit und Sicherheit sind. Blutungsrisiken in dieser Patientengruppe müssen jedoch sorgfältig bedacht werden, insbesondere peri-interventionell oder bei behandlungsbedingter Thrombozytopenie. Die Fortschritte für das Verständnis und für die Behandlung von VTE bei Kindern mit malignen Erkrankungen sind beträchtlich, wobei laufende Studien zu verbesserten Strategien beitragen.

Keywords

venous thromboembolism - childhood cancer - anticoagulants - primary prevention

Schlüsselwörter

venöse Thromboembolien - Pädiatrische maligne Erkrankungen - Antikoagulation - Primäre Prävention


Publication History

Received: 17 May 2024

Accepted: 27 August 2024

Article published online:
10 December 2024

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