Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Friday, January 4, 2019

Plastic Surgery

EDITORIAL 

The plagiarismp. 1
Cenk Demirdover
DOI:10.4103/1300-6878.249406  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW ARTICLETop

A general evaluation of stem cell studies and human cloning from the ethical, faith, and legal perspectivep. 3
Cemal Alper Kemaloglu, Fatih Birtek
DOI:10.4103/tjps.tjps_46_18  
Stem cell and cloning studies bear promising potential in the field of regenerative medicine with their exciting and innovative features. The wide range of applications of these cellular treatments and their permanent repairing qualities foretell that a completely different scientific paradigm is emerging for the future. However, satisfactory insight has not yet been developed with respect to the moral status and legal aspects of these studies. Furthermore, their potentially untoward side effects are not understood well enough to compare with the benefits they provide for human life. In general, attempts are made to place the subject in a pattern composed of the sanctity of life, the unique characteristics of being an individual, the boundaries drawn by beliefs, and the basic principles of law. This article will discuss the benefits of stem cell and cloning studies as well as their undeveloped medical, ethical, religious, and legal aspects.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLESTop

Inferior gluteal artery perforator flap for closure of sacral defects after pilonidal sinus surgeryp. 9
Zulfikar Ulas Bali, Anvar Ahmedov, Burak Ozkan, Mustafa Mazican, Yavuz Kececi
DOI:10.4103/tjps.tjps_36_18  
Introduction: The aim of the current study was to introduce the use of the inferior gluteal artery perforator flap (IGAPF) as a new alternative surgical technique for closure of sacral defects after pilonidal sinus surgery. Patients and Methods: Inferior gluteal artery perforators were used on 15 male patients operated in the plastic and reconstructive surgery department of our tertiary care centers between March 2014 and May 2017. Age, size of the defect, duration of follow-up, complications, and recurrence rate were assessed. Results: The average age was 30.2 (range: 17–54) years, and the mean duration of follow-up was 8.2 (range: 7–16) months. No recurrence was detected within the follow-up period, and the only remarkable complication reported was total flap necrosis attributed to venous congestion in one patient. The mean size of the defects after excision was 21.6 cm2Conclusion: Our preliminary results imply that IGAPF can be a safe and effective alternative for closure of large defects after pilonidal sinus surgery. Further controlled trials on larger series are warranted to establish the advantages and disadvantages of this alternative technique.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Complicated fingertip defects: Clinical approach to their reconstruction and the flaps that can be used in emergency settingsp. 14
Ozay Ozkaya Mutlu, Ozlem Colak, Ahmet Dilber, Derya Bingol, Onur Egemen
DOI:10.4103/tjps.tjps_43_18  
Aim: Numerous flaps have been described for the reconstruction of complicated defects of the fingertip. The aim of this study was to evaluate our experience on flaps that can be used in emergency settings, and analyze the outcomes of these procedures. Materials and Methods: A retrospective analysis of 81 patients, who presented to the emergency unit with complicated fingertip defects between 2009 and 2014 and in whom replantation was deemed unsuitable due to various reasons including crush or avulsion type of injury mechanism, absence of the amputated part, or unrepairable vascular injury in the amputate, was carried out. Results: Eighty-nine flaps were performed in 81 patients. The defects were repaired with V-Y advancement flaps in 57% (45 patients – 51 fingers) of the defects, kite flap in 15% (13 patients – 13 fingers), cross-finger flap in 12% (11 patients – 11 fingers), Kutler flap in 6% (4 patients – 5 fingers), digital artery perforator flap in 6% (4 patients – 5 fingers), and thenar flap in 4% (4 patients – 4 fingers) of the injuries. One patient operated with the digital artery perforator flap, and one other operated with the kite flap, developed partial flap necroses. There were no other complications. Conclusion: Functional and esthetic restoration of soft tissues in the fingers is possible with the use of appropriate flaps and meticulous surgical technique.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Epidemiological and localization characteristics of non-melanoma skin cancers: Retrospective analysis of 400 casesp. 19
Siddika Findik, Orkun Uyanik, Mahmut Altuntas, Zeynep Altuntas
DOI:10.4103/tjps.tjps_45_18  
Aim: In this study, it was aimed to investigate the epidemiological and localization characteristics of the patients diagnosed with nonmelanocytic skin cancer (NMSC). Materials and Methods: Histopathologic results of patients diagnosed with NMSC in the Pathology Department of Necmettin Erbakan University, Meram School of Medicine, between 2007 and 2017 were retrospectively reviewed. The age, sex, tumor type, and localization of the patients were investigated. Results: A totals of 400 patients diagnosed with NMSC were identified. 220 of the patients were male (55%) and 180 were female (45%). The male to female ratio was 220/180 (1.22). The age range was 10–105-year-old and the mean age was 67.8. Basal cell carcinoma (BCC) was found in 263 patients (65%), squamous cell carcinoma (SCC) in 114 patients (28%) and baso SCC (BSCC) in 12 patients (3%). BCC and SCC were observed together in 9 patients. BCC was most commonly detected in the nasal region with (31%) 82 patients (50%). SHC was most commonly detected in the lower lip region with 26 patients (22%). The localization of the BSCC was most common in the nasal region with 6 patients (%50). The rate of BCC/SCC in the nasal region was 82/11. The BCC/SCC ratio in the extremity region was 4/14. Conclusion: In our region, the most frequent histopathologic diagnosis was found BCC in patients prediagnosed with NMSC, and most cases were seen in male patients. In cases of BCC a BSCC, the most common tumor localization was nose area while it was lower lip area in SCC cases. In addition, BCC and BSCC were not detected in the lower lip.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

A retrospective analysis of tandoor burn injuries in Eastern Anatoliap. 23
Nese Kurt Ozkaya, Safak Aktar, Said Algan, Huseyin Akkaya
DOI:10.4103/tjps.tjps_47_18  
Aims: This study was to determine the severity of the tandoor burns in a city in Eastern Anatolia and to attract attention for the prevention of tandoor burns. Subjects and Methods: A retrospective evaluation was made of the registration data of burns hospitalized. A record was made of patient variables including burn type, age, gender, socioeconomic status, and amputation site and level. Statistical Analysis Used: Descriptive statistics were used to summarize the data, and results were reported as number and percentage. Categorical variables were evaluated with the Chi-square test. P < 0.05 was considered statistically significant. Results: To emphasize the importance of tandoor burns, the data were classified as tandoor (8.8%) and other types of burns (91.2%). Tandoor burns were the fourth-most common cause of burn. While the rate of amputation in other burn types was 1.26%, the amputation rate was 9.09% in tandoor burns. In the 0–3 years of age group, the percentage of tandoor burns was significantly higher. In respect of tandoor burns, more amputations were performed on children than on adults. Conclusions: Tandoor is used in many places in the world for various purposes (as sociocultural habits, cooking, and warming, especially in low-socioeconomic areas). Increasing protective measures in the use of tandoor may be useful for reducing the amputations due to tandoor burns and its possible long lifetime consequences. Because, unfortunately, tandoor burns are a significant cause of amputations in children-foot amputations in particular.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
CASE REPORTSTop

An unusual dog bite in an infant with penetrating brain injury and scalp lossp. 30
Sheerin Shah, Hanish Bansal, Rajinder K Mittal, Ashwani K Chaudhary, Sanjeev Uppal, Ramneesh Garg, Soheb Rafique, Jagminder Singh
DOI:10.4103/tjps.tjps_52_18  
The spectrum of bites varies from superficial scraches till deep avulsion of tissues. Children especially infants , because of inherent inability to defense against dogs , are more liable to get their bites. We report an interesting case of dog bite in a 5 months old infant.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

A progressed case of Stewart–Treves syndrome in a patient with chronic idiopathic lymphedema in the lower extremityp. 33
Mehmet Ozdemir, Muhammed Sulaiman Sultany, Ercan Celikkaleli, Burhan Ozalp
DOI:10.4103/tjps.tjps_58_18  
Angiosarcomas are uncommon malignant tumors that arise from vascular endothelial cells with poor prognosis. Stewart–Treves syndrome (STS) is a type of cutaneous angiosarcoma that develops in chronic lymphedema. Although the majority of lymphangiosarcomas arise from areas of lymphedema as a consequence of lymph node dissection in radical mastectomy, it has also occurred in other causes of lymphedema. In the pathophysiology of lymphangiosarcoma, impairment of the local immune response and induced angiogenesis are emphasized. A 69-year-old male patient with a previous diagnosis of chronic lymphedema in his left lower limb presented with STS and widespread metastases. The patient refused the treatment for lymphedema and ignored the lesion due to its innocuous appearance. In addition, during the presentation, he had Stage 4 disease and, therefore, he was not a candidate for curative operative treatment. Early tumor resection or limb amputation has the best outcomes in the treatment.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Recalcitrant desmoid tumor of the abdominal wall: A reconstructive dilemmap. 36
Prakash Chandra Kala, Ranjit Kumar Sahu, Ramkaran Choudhary, Ashok Puranik
DOI:10.4103/tjps.tjps_64_18  
Desmoid tumors are slow-growing benign tumors. These tumors infiltrate surrounding tissues but not malignant and associated with women of fertile age, especially during and after pregnancy. We report a young male patient with a recurrent desmoid tumor of the anterior abdominal wall who underwent resection four times earlier. The patient had a history of four-time operation over the same site for the same disease. Preoperative evaluation included thorough clinical examination with abdominal ultrasound. The histology revealed a desmoid tumor. Primary surgical resection and immediate reconstruction of abdominal defect were performed.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
LETTER TO THE EDITORTop

Role of tumor-infiltrating lymphocytes in melanomap. 39
Yasemin Benderli Cihan
DOI:10.4103/tjps.tjps_49_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Translational Critical Care Medicine

Preface of Journal of Translational Critical Care Medicine
Kaijiang Yu, Zhiyong Peng

Journal of Translational Critical Care Medicine 2019 1(1):1-1



Translational Critical Care Medicine: Integrating State-of-the-Art Knowledge between Bench and Bedside
Xiaofeng Jia, Zhiyong Peng

Journal of Translational Critical Care Medicine 2019 1(1):2-3



Combining Therapy of Octreotide and Glucocorticoid in the Treatment of a Lung Adenocarcinoma Patient with Acute Respiratory Distress Syndrome
Xue-Zhong Xing, Hai-Jun Wang, Shi-Ning Qu, Chu-Lin Huang

Journal of Translational Critical Care Medicine 2019 1(1):4-6

A 63-year-old male who was diagnosed with adenocarcinoma of the right lower lobe presented with 1 week of fever, cough, and progressive dyspnea and admitted to the Intensive Care Unit (ICU). After intubation, physical examination revealed copious, light bloody sputum and diffuse crackles and rales on lung auscultation. The patient was diagnosed as Stage IV adenocarcinoma, septic shock (lung infection), and acute respiratory distress syndrome. His oxygenation failed to improve despite sedation, restrictive fluid therapy, and methylprednisolone, antimicrobials therapy, protective ventilation, plasma supplement, and anticoagulation. Respiratory secretions suctioned from her endotracheal tube averaged 1.0 L daily. On day 2 after admission, octreotide was infused to control sputum volume. The patient&#39;s respiratory secretions decreased significantly, and on day 8, the ventilator mode was changed to pressure support ventilation, and the patient was extubated and dismissed from ICU. 


Angiotensin in Clinical Practice
Ehsan Ahmadnia, Anna Hall, Marlies Ostermann

Journal of Translational Critical Care Medicine 2019 1(1):7-11

Interest in the use of angiotensin (AT) (particularly in the context of shock) had been rekindled by recent randomized trial data (notably the AT II for the Treatment of High-Output Shock-3 study). This review article outlines the renin&#8211;AT system in health and during sepsis as well as the proposed clinical uses of AT II. The potential for wider application within critical care is also considered. 


Multimodal Monitoring Technologies for Pathophysiology and Management of Traumatic Brain Injury
Yujie Chen, Qianwei Chen, Jian Sun, Lijun Zhang, Liang Tan, Hua Feng

Journal of Translational Critical Care Medicine 2019 1(1):12-19

Despite decades of efforts, severe traumatic brain injury (TBI) is still the leading cause for mortality and immobility of children and young adults worldwide and is a great burden to the health-care system. After injury, the oxygen supply is conventionally considered the monitoring parameter in a neurosurgical Intensive Care Unit. However, the overall mortality rate has only slightly improved since the late twentieth century. Evolving evidence suggests that dysfunction of oxygen utilization might be the underlying pathophysiology of secondary brain injury, which should also be a key parameter for multimodal monitoring and management after severe TBI. In this review, we summarize the current and advanced understanding of multimodal monitoring for severe TBI along with novel noninvasive technologies in this field. By continuously monitoring patients with severe TBI, the use of multimodal monitoring technologies including (but not limited to) computed tomography, cerebral microdialysis, near-infrared spectroscopy, magnetic resonance spectroscopy, high-performance liquid chromatography, and magnetic induction phase shift method will be crucial for observing disease changes such as intracranial pressure and brain tissue oxygen partial pressure as well as developing potential therapeutic strategies after severe TBI. 


Neuromonitoring in Malignant Middle Cerebral Artery Infarction: A Review of Literature
Songyu Chen, Ke Wang, Chengcheng Zhou, Sajan Pandey, Liang Gao

Journal of Translational Critical Care Medicine 2019 1(1):20-27

Malignant middle cerebral artery infarction is a devastating subtype of ischemic stroke, which carries a significant mortality rate (up to 80&#37;) despite of conservative treatment. On the other hand, surgical decompressive procedure is the only established therapy to rescue the adverse effects of malignant edema and thus improve outcome. Accordingly, the early recognition of a possible malignant course as well as prediction of outcome is crucial for clinical decision-making. Numerous neuromonitoring techniques have been applied to address this issue. In theory, these techniques have the potential to present the information needed to guide targeted and timely intervention before irreversible damage takes place. However, the results were heterogeneous yet conflicting. We examined and summarized the recent evidence in this review, which may shed light on current trends.


Using Clinical Decision Support Systems for Acute Kidney Injury Pragmatic Trials
Kianoush Kashani, Nooshin Dalili, Rickey E Carter, John A Kellum, Ravindra L Mehta

Journal of Translational Critical Care Medicine 2019 1(1):28-34

Following the initial introduction of clinical decision support systems (CDSS) into the clinical practice in the 1970s, the complexity and performance quality of CDSSs have increased. The current literature on the efficacy and effectiveness of such systems shows conflicting results. While some studies show a clear benefit in quality-of-care improvement, others fail to replicate these outcomes. Heterogeneity of studies and the complexity of CDSS characteristics drive these conflicting conclusions. The lower cost and the easier implementation of pragmatic clinical trials provide an excellent platform to prove the effectiveness of CDSS in the real-world scenarios. To achieve better results, a series of explanatory trials are needed to identify the most effective CDSS in controlled settings. Therefore, utilization of both explanatory and pragmatic trial designs is necessary to evaluate the safety and efficacy of CDSS on the care of patients with acute kidney injury (AKI) in the acute setting. In this review, the authors provide an overview of the literature on critical care-related CDSS, its characteristics and dimensions, differences between pragmatic and explanatory trials, and potential proposals for both trial designs for AKI. 


The Short- and Long-Term Burden of Acute Kidney Injury
Jonah G Powell-Tuck, Jorge Cerda, Marlies Ostermann

Journal of Translational Critical Care Medicine 2019 1(1):35-41

Acute kidney injury (AKI) is a common complication of acute illness and carries a significant risk of mortality and morbidity, resulting in high health-care-associated costs. The incidence of AKI appears to be rising, making it ever more important to understand its acute and chronic consequences. In this review, we explore the evolving epidemiology of AKI, describe the impact of AKI on other organs, and discuss the short- and long-term effects of AKI on mortality and morbidity and its economic burden. 


The 19th Acute Disease Quality Initiative (ADQI) Meeting Report
Zhiyong Peng

Journal of Translational Critical Care Medicine 2019 1(1):42-43



EDITORIALS 

Preface of Journal of Translational Critical Care Medicinep. 1
Kaijiang Yu, Zhiyong Peng
DOI:10.4103/jtccm.jtccm_16_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Translational Critical Care Medicine: Integrating State-of-the-Art Knowledge between Bench and Bedsidep. 2
Xiaofeng Jia, Zhiyong Peng
DOI:10.4103/jtccm.jtccm_18_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
CONSENSUS REPORTTop

Combining Therapy of Octreotide and Glucocorticoid in the Treatment of a Lung Adenocarcinoma Patient with Acute Respiratory Distress Syndromep. 4
Xue-Zhong Xing, Hai-Jun Wang, Shi-Ning Qu, Chu-Lin Huang
DOI:10.4103/jtccm.jtccm_8_18  
A 63-year-old male who was diagnosed with adenocarcinoma of the right lower lobe presented with 1 week of fever, cough, and progressive dyspnea and admitted to the Intensive Care Unit (ICU). After intubation, physical examination revealed copious, light bloody sputum and diffuse crackles and rales on lung auscultation. The patient was diagnosed as Stage IV adenocarcinoma, septic shock (lung infection), and acute respiratory distress syndrome. His oxygenation failed to improve despite sedation, restrictive fluid therapy, and methylprednisolone, antimicrobials therapy, protective ventilation, plasma supplement, and anticoagulation. Respiratory secretions suctioned from her endotracheal tube averaged 1.0 L daily. On day 2 after admission, octreotide was infused to control sputum volume. The patient's respiratory secretions decreased significantly, and on day 8, the ventilator mode was changed to pressure support ventilation, and the patient was extubated and dismissed from ICU.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW ARTICLESTop

Angiotensin in Clinical Practicep. 7
Ehsan Ahmadnia, Anna Hall, Marlies Ostermann
DOI:10.4103/jtccm.jtccm_1_18  
Interest in the use of angiotensin (AT) (particularly in the context of shock) had been rekindled by recent randomized trial data (notably the AT II for the Treatment of High-Output Shock-3 study). This review article outlines the renin–AT system in health and during sepsis as well as the proposed clinical uses of AT II. The potential for wider application within critical care is also considered.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Multimodal Monitoring Technologies for Pathophysiology and Management of Traumatic Brain Injuryp. 12
Yujie Chen, Qianwei Chen, Jian Sun, Lijun Zhang, Liang Tan, Hua Feng
DOI:10.4103/jtccm.jtccm_2_18  
Despite decades of efforts, severe traumatic brain injury (TBI) is still the leading cause for mortality and immobility of children and young adults worldwide and is a great burden to the health-care system. After injury, the oxygen supply is conventionally considered the monitoring parameter in a neurosurgical Intensive Care Unit. However, the overall mortality rate has only slightly improved since the late twentieth century. Evolving evidence suggests that dysfunction of oxygen utilization might be the underlying pathophysiology of secondary brain injury, which should also be a key parameter for multimodal monitoring and management after severe TBI. In this review, we summarize the current and advanced understanding of multimodal monitoring for severe TBI along with novel noninvasive technologies in this field. By continuously monitoring patients with severe TBI, the use of multimodal monitoring technologies including (but not limited to) computed tomography, cerebral microdialysis, near-infrared spectroscopy, magnetic resonance spectroscopy, high-performance liquid chromatography, and magnetic induction phase shift method will be crucial for observing disease changes such as intracranial pressure and brain tissue oxygen partial pressure as well as developing potential therapeutic strategies after severe TBI.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Neuromonitoring in Malignant Middle Cerebral Artery Infarction: A Review of Literaturep. 20
Songyu Chen, Ke Wang, Chengcheng Zhou, Sajan Pandey, Liang Gao
DOI:10.4103/jtccm.jtccm_3_18  
Malignant middle cerebral artery infarction is a devastating subtype of ischemic stroke, which carries a significant mortality rate (up to 80%) despite of conservative treatment. On the other hand, surgical decompressive procedure is the only established therapy to rescue the adverse effects of malignant edema and thus improve outcome. Accordingly, the early recognition of a possible malignant course as well as prediction of outcome is crucial for clinical decision-making. Numerous neuromonitoring techniques have been applied to address this issue. In theory, these techniques have the potential to present the information needed to guide targeted and timely intervention before irreversible damage takes place. However, the results were heterogeneous yet conflicting. We examined and summarized the recent evidence in this review, which may shed light on current trends.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Using Clinical Decision Support Systems for Acute Kidney Injury Pragmatic Trialsp. 28
Kianoush Kashani, Nooshin Dalili, Rickey E Carter, John A Kellum, Ravindra L Mehta
DOI:10.4103/jtccm.jtccm_6_18  
Following the initial introduction of clinical decision support systems (CDSS) into the clinical practice in the 1970s, the complexity and performance quality of CDSSs have increased. The current literature on the efficacy and effectiveness of such systems shows conflicting results. While some studies show a clear benefit in quality-of-care improvement, others fail to replicate these outcomes. Heterogeneity of studies and the complexity of CDSS characteristics drive these conflicting conclusions. The lower cost and the easier implementation of pragmatic clinical trials provide an excellent platform to prove the effectiveness of CDSS in the real-world scenarios. To achieve better results, a series of explanatory trials are needed to identify the most effective CDSS in controlled settings. Therefore, utilization of both explanatory and pragmatic trial designs is necessary to evaluate the safety and efficacy of CDSS on the care of patients with acute kidney injury (AKI) in the acute setting. In this review, the authors provide an overview of the literature on critical care-related CDSS, its characteristics and dimensions, differences between pragmatic and explanatory trials, and potential proposals for both trial designs for AKI.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The Short- and Long-Term Burden of Acute Kidney Injuryp. 35
Jonah G Powell-Tuck, Jorge Cerda, Marlies Ostermann
DOI:10.4103/jtccm.jtccm_7_18  
Acute kidney injury (AKI) is a common complication of acute illness and carries a significant risk of mortality and morbidity, resulting in high health-care-associated costs. The incidence of AKI appears to be rising, making it ever more important to understand its acute and chronic consequences. In this review, we explore the evolving epidemiology of AKI, describe the impact of AKI on other organs, and discuss the short- and long-term effects of AKI on mortality and morbidity and its economic burden.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
MEETING REPORTTop

The 19th Acute Disease Quality Initiative (ADQI) Meeting Reportp. 42
Zhiyong Peng
DOI:10.4103/jtccm.jtccm_17_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Thursday, January 3, 2019

How I treat venous thrombosis in children Contraindications to specific antithrombotic therapies in infants and children


Unfractionated heparin
   Known allergy
   History of HITs
Low-molecular-weight heparin
   Known allergy
   History of HITs
   Invasive procedure within the previous 24 h
Systemic TPA
   Known allergy
   Active bleeding
   Central nervous system ischemia/hemorrhage/surgery within the previous 10 d (includes birth asphyxia)
   Surgery within the previous 7 d
   Invasive procedure within the previous 3 d
   Seizures within the previous 48 h
Thrombolysis by interventional radiology
   Known allergy
   In cases where needed, inability to place a vena cava filter
   Limitations are size of involved vessels and experience of interventionalists


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895344/