Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Shannon Carpenter
Presentation Type
Oral Presentation
Start Date
12-5-2026 12:30 PM
End Date
12-5-2026 12:45 PM
Abstract Text
Background:
Management of thromboembolism (TE) in pediatric acute myeloid leukemia (AML) is challenging due to prolonged periods of thrombocytopenia and associated bleeding. There are no guidelines for anticoagulation for children with AML.
Objectives/Goal:
This study aims to understand anticoagulation utilization and association with bleeding events in hospitalized children with AML, both with and without thromboses.
Methods/Design:
We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) administrative database of index hospitalizations for patients 1-21 years of age upon admission in 2016-2024 with the diagnosis of AML. Patients with bleeding disorders, thrombophilia, and acute promyelocytic leukemia were excluded.
Demographic data, diagnosis of TE, anticoagulation use, and bleeding events (BE) were extracted. Any ICD-10 code corresponding to TE was included, such as deep venous thrombosis, arterial thrombosis, pulmonary embolism, and thrombosis of the central nervous system; any ICD-10 code corresponding to bleeding was categorized as a BE. Evaluated anticoagulants included low molecular weight heparins, oral thrombin inhibitors, oral factor Xa inhibitors, and the vitamin K antagonist warfarin. Continuous anticoagulants, such as unfractionated heparin and bivalirudin, were excluded due to their role in complex critical care outside of the management of thrombosis. While dosing information was unavailable, use for presumed prophylaxis was defined as patients receiving anticoagulation in the absence of a TE.
Comparisons were made using Chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.
Results:
3,768 patients with AML were included from 49 PHIS hospitals with 167 (4.4%) experiencing a TE. Patients with TEs tended to be older than those without TEs (median [IQR]: 13 years [7, 17] vs. 10 [3, 15]; p< 0.001). Among the 167 patients with TEs, 62.3% experienced an extremity venous TE, which was the most frequent site identified. The presence of a TE was associated with longer hospital stays (36 days [25, 60] vs. 28 [6, 37]), more ICU days (1 [0, 9] vs. 0 [0, 1]), greater hospital costs ($819,104 [$423,747, $1.4 million] vs. $414,980 [$126,701, $770,730]), and higher in-hospital mortality (13.8% vs. 3.4%) (all p< 0.001).
171 patients (4.5%) received anticoagulation. Almost half of these patients received anticoagulation for presumed prophylaxis (83/171; 48.5%). Of patients with a TE, 88 (52.3%) received anticoagulation, with the remainder receiving none. Enoxaparin was the most frequently utilized anticoagulant (150/171; 87.7%) followed by rivaroxaban (22 patients; 12.9%). Institutional variation was observed in anticoagulation use, with percentages of patients receiving any anticoagulation ranging from 0 to 12.2% (median [IQR]: 3.57, [1.47, 5.91]).
A total of 750 patients (20% of cohort) experienced ≥1 BE. Most patients with BE received no anticoagulation (705/750; 94%). The occurrence of a BE was not significantly related to whether the patient received no anticoagulation, presumed prophylaxis, or anticoagulation in the setting of a TE (p=0.055).
Conclusions:
Anticoagulation practices for pediatric patients with AML vary widely by institution. Prospective research is needed to determine the most safe and effective strategies for prophylactic and therapeutic anticoagulation in this population.
Current practices of anticoagulant utilization in pediatric patients with acute myeloid leukemia (AML)
Background:
Management of thromboembolism (TE) in pediatric acute myeloid leukemia (AML) is challenging due to prolonged periods of thrombocytopenia and associated bleeding. There are no guidelines for anticoagulation for children with AML.
Objectives/Goal:
This study aims to understand anticoagulation utilization and association with bleeding events in hospitalized children with AML, both with and without thromboses.
Methods/Design:
We performed a retrospective cohort study using the Pediatric Health Information System (PHIS) administrative database of index hospitalizations for patients 1-21 years of age upon admission in 2016-2024 with the diagnosis of AML. Patients with bleeding disorders, thrombophilia, and acute promyelocytic leukemia were excluded.
Demographic data, diagnosis of TE, anticoagulation use, and bleeding events (BE) were extracted. Any ICD-10 code corresponding to TE was included, such as deep venous thrombosis, arterial thrombosis, pulmonary embolism, and thrombosis of the central nervous system; any ICD-10 code corresponding to bleeding was categorized as a BE. Evaluated anticoagulants included low molecular weight heparins, oral thrombin inhibitors, oral factor Xa inhibitors, and the vitamin K antagonist warfarin. Continuous anticoagulants, such as unfractionated heparin and bivalirudin, were excluded due to their role in complex critical care outside of the management of thrombosis. While dosing information was unavailable, use for presumed prophylaxis was defined as patients receiving anticoagulation in the absence of a TE.
Comparisons were made using Chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables.
Results:
3,768 patients with AML were included from 49 PHIS hospitals with 167 (4.4%) experiencing a TE. Patients with TEs tended to be older than those without TEs (median [IQR]: 13 years [7, 17] vs. 10 [3, 15]; p< 0.001). Among the 167 patients with TEs, 62.3% experienced an extremity venous TE, which was the most frequent site identified. The presence of a TE was associated with longer hospital stays (36 days [25, 60] vs. 28 [6, 37]), more ICU days (1 [0, 9] vs. 0 [0, 1]), greater hospital costs ($819,104 [$423,747, $1.4 million] vs. $414,980 [$126,701, $770,730]), and higher in-hospital mortality (13.8% vs. 3.4%) (all p< 0.001).
171 patients (4.5%) received anticoagulation. Almost half of these patients received anticoagulation for presumed prophylaxis (83/171; 48.5%). Of patients with a TE, 88 (52.3%) received anticoagulation, with the remainder receiving none. Enoxaparin was the most frequently utilized anticoagulant (150/171; 87.7%) followed by rivaroxaban (22 patients; 12.9%). Institutional variation was observed in anticoagulation use, with percentages of patients receiving any anticoagulation ranging from 0 to 12.2% (median [IQR]: 3.57, [1.47, 5.91]).
A total of 750 patients (20% of cohort) experienced ≥1 BE. Most patients with BE received no anticoagulation (705/750; 94%). The occurrence of a BE was not significantly related to whether the patient received no anticoagulation, presumed prophylaxis, or anticoagulation in the setting of a TE (p=0.055).
Conclusions:
Anticoagulation practices for pediatric patients with AML vary widely by institution. Prospective research is needed to determine the most safe and effective strategies for prophylactic and therapeutic anticoagulation in this population.
