ASH Clinical News ACN_4.14_Full Issue_web | Page 57

CLINICAL NEWS
One child who had an embolic stroke
22 days after CVC removal was receiving
15 U/kg/hour of UFH as thrombopro-
phylaxis, again suggesting that thrombo-
prophylaxis was ineffective in this population.
“Outcome data for children with and
without thrombosis did not differ,” the
authors concluded. “When compared
with the known risks of anticoagulation
in sick children, this would suggest that
asymptomatic CVC-RT, even in critically
unwell children, might not require specific
treatment.”
The following risk factors were as-
sociated with a higher likelihood of acute
CVC-RT during admission: cardiac
arrest, continuous UFH >10 U/kg/hour,
and a major or clinically relevant bleed-
ing episode. At two-year follow-up, only
having a CVC placed into the femoral
vein was associated with an increased
risk for residual CVC-RT ( TABLE 3 ).
“The study
highlights the
limitations of
[PTS scales] and
suggests that the
tools may have
differential value
in different age
groups.”
might “provide a more rational
approach to thromboprophy-
laxis in critically ill children.”
The authors report no con-
flicts of interest.
REFERENCE
Jones S, Butt W, Monagle P, et al. The natural history
of asymptomatic central venous catheter-related
thrombosis in critically ill children. Blood. 2018
October 30. [Epub ahead of print]
CVC Placement and CVC-Related Thrombosis at Admission
and Follow-Up
TABLE 3.
Admission
Two-Year Follow-Up
N Odds Ratio (95% CI) p Value N Odds Ratio (95% CI) p Value
Cardiac arrest 23 3.32 (1.29 – 8.55) 0.01 14 3.35 (0.89 – 12.49) 0.07
Hypotension 47 1.9 (0.85 – 4.28) 0.1 35 2.85 (0.98 – 8.34) 0.05
Bleeding 11 3.3 (0.93 – 11.67) 0.06 8 2.3 (0.43 – 12.7) 0.3
UFH >10 U/kg/hour 104 2.05 (0.63 – 6.7) 0.2 86 0.93 (0.1 – 8.2) 0.9
Femoral placement 33 1.27 (0.16 to 9.9) 0.8 6 26.17 (1.5 to 443.2) 0.02
UFH = unfractionated heparin
Nuclear export
dysregulation is
stealing the cell’s
valuable anti-tumor
defenses 1
—SOPHIE JONES, PhD
Among the 126 children who under-
went PTS assessments, 13 (10.3%) had
some degree of PTS, and two met the
criteria for clinically significant PTS, ac-
cording to scores on the Manco-Johnson
Instrument (MJI) and the Modified Vil-
lalta (MV) Scale. The authors added that
there were substantial differences between
the scoring tools, noting the inconsistency
in the classification, diagnosis, and report-
ing of PTS in children as a limitation
of this analysis. Also, the inclusion of a
predominantly young cohort, mostly with
congenital heart disease as the primary
diagnosis may limit the generalizability of
the findings to other children with CVCs
or those with critical illness.
“The study highlights the limitations
of the MV and MJI tools and suggests
that the tools may have differential value
in different age groups of children,” the
authors concluded. For children with mul-
tiple risk factors for CVC-RT (like femoral
placement of CVC), the researchers
recommend that future studies attempt to
develop risk-stratification methods that
IT’S ONE OF THE GREATEST HEISTS IN
CANCER, AND NO ONE SAW IT COMING.
Dysregulated nuclear export has been secretly depleting
the nucleus of key anti-oncogenic proteins, allowing the
tumor to proliferate and survive. 1,2
Investigate the evidence at NuclearExport.com
References: 1. Gupta A, Saltarski JM, White MA, Scaglioni PP, Gerber DE. Therapeutic targeting of nuclear export inhibition
in lung cancer. J Thorac Oncol. 2017;12(9):1446-1450. 2. Sun Q, Chen X, Zhou Q, Burstein E, Yang S, Jia D. Inhibiting cancer
cell hallmark features through nuclear export inhibition. Signal Transduct Target Ther. 2016;1:16010.
Karyopharm and the logo designs presented in this material are registered trademarks of Karyopharm Therapeutics.
Karyopharm Therapeutics | 85 Wells Ave, Newton, MA 02459
© 2018 Karyopharm Therapeutics. All rights reserved. US-NON-09/18-00004
ASHClinicalNews.org