Perinatal/Pediatric Haemostasis

July 13, 2003
08:00 to 12:00
Hall 11
The International Convention Center, Birmingham

Chairman:  U. Nowak-Göttl, Germany
Co-chairs:  B. Brenner, Israel; E. F. Grabowski, USA; G. Kenet, Israel; P. Massicotte, Canada;
P. Mathew, USA; W. Muntean, Austria; N. Schlegel, France

The chair and co-chairs and approximately 240 Subcommittee members were present. Issues discussed were as follows:
  1. Perinatal hemostasis: This issue was presented by B. Brenner, G. Kenet, and G. Cvirn. B. Brenner reported on the favorable outcome of newborns of mothers treated with LMWH due to previously reported pregnancy complications, and G. Kenet et al. underlined the need for further research with respect to the role of thrombophilia in perinatal complications in preterm and term babies. With respect to a clinically observed well-functioning hemostasis in neonates G. Cvirn et al. demonstrated that, despite different amounts of plasma clotting factor inhibitors in term infants compared with adults, the rate of thrombin formation is similar.

  2. Thrombosis issues: These topics were presented by C. Male, G. deVeber, F. Kirkham, G. Kenet and R. Sträter. C. Male et al. demonstrated the need for standardized research with respect to central line-associated (CVL) thrombosis in children. The authors pointed out that CVL location and CVL insertion technique are responsible in the majority of cases for the different rates of thrombosis diagnosed with objective imaging methods. G. deVeber, F. Kirkham , G. Kenet and R. Sträter reported on cerebral venous thrombosis (CVT) in children with respect to clinical presentation, diagnostic imaging methods, underlying diseases, treatment and outcome. All authors agreed that CVT in children is a multifactorial disorder and underlined the need for larger multi-national studies or registries to receive additional and comparable data of outcome and treatment safety. The future of therapeutic studies was discussed.

  3. Anticoagulation issues/new study protocols: This topic was covered by P. Massicotte, L. Mitchell, A. Chan, and B. Zieger. P. Massicotte and L. Mitchell pointed out that randomized clinical trials are urgently required in children to determine the safest and most effective heparin therapy, UFH as well as LMWH, for venous thrombosis. B. Zieger underlined the need for further studies in children with heparin-induced thrombocytopenia type II treated with recombinant hirudin. In an animal model A. Chan introduced a new anticoagulant (antithrombin-heparin covalent complex to be coated to CVLs) which shows a clear reduction in thrombus formation in comparison with uncoated CVLs.

  4. Bleeding disorders: P. Mathew reported on the use of recombinant factor VIIa (rFVIIa) in the treatment of non-hemophilic bleeding disorders in children. He summarized the data previously published on 30 children. However, since no controlled studies are available, P. Mathew and the SSC members concluded that randomized trials are urgently needed to prove the efficacy and safety of rFVIIA in bleeding situations of non-hemophilic children. J. Bussel discussed the need for a national and international registry to record more information on clinical presentation, treatment and outcome of acute and chronic ITP in children.

  5. Discussion: A position paper on "platelet function disorders/acute and chronic ITP" introduced by N. Schlegel as a possible SSC report was discussed. B. Brenner presented an SSC position paper on "Thrombophilia and pregnancy complications in cooperation with the working group on Women’s Health Issues: Maternal, fetal and newborn issues", and L. Mitchell introduced the position paper on "Recommendations for the use of both ultrasound and venography for diagnosis of venous thromboembolism in children". The SSC chair and co-chairs agreed to the three SSC report proposals.