Diagnosis and Treatment > Medication > Enoxaparin
You are looking at 1 - 2 of 2 items
Search for other papers by Daphne Yau in
Google Scholar
PubMed
Search for other papers by Maria Salomon-Estebanez in
Google Scholar
PubMed
Search for other papers by Amish Chinoy in
Google Scholar
PubMed
Search for other papers by John Grainger in
Google Scholar
PubMed
Search for other papers by Ross J Craigie in
Google Scholar
PubMed
Search for other papers by Raja Padidela in
Google Scholar
PubMed
Search for other papers by Mars Skae in
Google Scholar
PubMed
Search for other papers by Mark J Dunne in
Google Scholar
PubMed
Search for other papers by Philip G Murray in
Google Scholar
PubMed
Search for other papers by Indraneel Banerjee in
Google Scholar
PubMed
Summary
Congenital hyperinsulinism (CHI) is an important cause of severe hypoglycaemia in infancy. To correct hypoglycaemia, high concentrations of dextrose are often required through a central venous catheter (CVC) with consequent risk of thrombosis. We describe a series of six cases of CHI due to varying aetiologies from our centre requiring CVC for the management of hypoglycaemia, who developed thrombosis in association with CVC. We subsequently analysed the incidence and risk factors for CVC-associated thrombosis, as well as the outcomes of enoxaparin prophylaxis. The six cases occurred over a 3-year period; we identified an additional 27 patients with CHI who required CVC insertion during this period (n = 33 total), and a separate cohort of patients with CHI and CVC who received enoxaparin prophylaxis (n = 7). The incidence of CVC-associated thrombosis was 18% (6/33) over the 3 years, a rate of 4.2 thromboses/1000 CVC days. There was no difference in the frequency of genetic mutations or focal CHI in those that developed thromboses. However, compound heterozygous/homozygous potassium ATP channel mutations correlated with thrombosis (R 2 = 0.40, P = 0.001). No difference was observed in CVC duration, high concentration dextrose or glucagon infused through the CVC. In patients receiving enoxaparin prophylaxis, none developed thrombosis or bleeding complications. The characteristics of these patients did not differ significantly from those with thrombosis not on prophylaxis. We therefore conclude that CVC-associated thrombosis can occur in a significant proportion (18%) of patients with CHI, particularly in severe CHI, for which anticoagulant prophylaxis may be indicated.
Learning points:
-
CVC insertion is one of the most significant risk factors for thrombosis in the paediatric population.
-
Risk factors for CVC-associated thrombosis include increased duration of CVC placement, malpositioning and infusion of blood products.
-
To our knowledge, this is the first study to evaluate CVC-associated thrombosis in patients with congenital hyperinsulinism (CHI).
-
The incidence of CVC-associated thrombosis development is significant (18%) in CHI patients and higher compared to other neonates with CVC. CHI severity may be a risk factor for thrombosis development.
-
Although effective prophylaxis for CVC-associated thrombosis in infancy is yet to be established, our preliminary experience suggests the safety and efficacy of enoxoaparin prophylaxis in this population and requires on-going evaluation.
Search for other papers by T Min in
Google Scholar
PubMed
Search for other papers by S Benjamin in
Google Scholar
PubMed
Search for other papers by L Cozma in
Google Scholar
PubMed
Summary
Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initiation of anticoagulation for atrial fibrillation in severe thyrotoxicosis. Anticoagulation is not routinely initiated if the risk is low on a CHADS2 score; however, this should be considered in patients with thyroid storm or severe thyrotoxicosis with impending storm irrespective of the CHADS2 risk, as it appears to increase the risk of thromboembolic episodes. Herein, we describe a case of thyroid storm complicated by massive pulmonary embolism.
Learning points
-
Diagnosis of thyroid storm is based on clinical findings. Early recognition and prompt treatment could lead to a favourable outcome.
-
Hypercoagulable state is a recognised complication of thyrotoxicosis.
-
Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm.
-
Anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score.
-
Patients with severe thyrotoxicosis and clinical evidence of thrombosis should be immediately anticoagulated until hyperthyroidism is under control.
