Document Type
Article
Journal Title
Blood Advances
Publication Date
2025
Volume
9
Abstract
We conducted this systematic review to evaluate outcomes of thrombolysis followed by anticoagulation vs anticoagulation alone in pediatric patients with venous thromboembolism (VTE). This systematic review addresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in 5 PICO (population, intervention, comparison, outcomes) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT). Meta-analysis reported risk ratios or differences (95% confidence intervals [CIs]), and absolute effects per 1000 patients. Certainty of evidence was assessed using GRADE (Grading of recommendation, assessment, Development, and Evaluation) guidelines. Thirteen nonrandomized studies were included and no randomized clinical trials addressed these questions. Thrombolysis might be associated with a higher risk of major bleeding, clinically relevant nonmajor bleeding, or unspecified bleeding with risk differences of 0.09 (95% CI, -0.06 to 0.23), 0.06 (95% CI, -0.11 to 0.22), and 0.09 (95% CI, -0.04 to 0.23), respectively. In PE with hemodynamic compromise, thrombolysis might be associated with a lower risk of mortality but conclusions on PE progression were uncertain in submassive PE. In DVT, thrombolysis may have little to no effect on mortality or thrombus resolution but might be associated with lower risk of postthrombotic syndrome. In RAT, thrombolysis might have little to no effect on thrombus resolution but a higher risk of major bleeding and mortality. For CSVT and RVT, the evidence was very limited. These findings were based on very-low-certainty evidence because of confounding and imprecision from small sample sizes. This systematic review highlights key challenges in developing recommendations for thrombolysis in children with VTE.
MeSH Headings
Humans, Venous Thromboembolism, Thrombolytic Therapy, Child, Treatment Outcome, Hemorrhage, Anticoagulants
DOI Link
ISSN
2473-9537
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Kawtharany, Hassan; Azzam, Muayad; Alkhader, Aseel; Betensky, Marisol; Hamarsha, Qais; Abou Zeid, Hadi K.; Mansour, Razan; Tabak, Carine; Patel, Payal; Baghdadi, Sarah L.; Bercovitz, Rachel S.; Bhat, Rukhmi; Biss, Tina; Branchford, Brian R.; Brandão, Leonardo R.; Chan, Anthony K.C.; Faustino, E. Vincent S.; Jaffray, Julie; Jones, Sophie; Kerlin, Bryce A.; Kucine, Nicole; Kumar, Riten; Male, Christoph; Pelland-Marcotte, Marie-Claude; Raffini, Leslie; Raulji, Chittalsinh M.; Sartain, Sarah E.; Takemoto, Clifford M.; Tarango, Cristina; van Ommen, C Heleen; Velez, Maria C.; Vesely, Sara K.; Wiernikowski, John; Williams, Suzan; Wilson, Hope P.; Woods, Gary; Zia, Ayesha; Monagle, Paul; and Mustafa, Reem A., "Efficacy and Safety of Thrombolysis for Pediatric Venous Thromboembolism: A Systematic Review and Meta-Analysis" (2025). Journal Articles: Pediatrics. 56.
https://digitalcommons.unmc.edu/com_peds_articles/56