A Multinational Study of Thromboprophylaxis Practice in Critically Ill Children*

Faustino, E. Vincent S.; Hanson, Sheila J.; Spinella, Philip C.; Tucci, Marisa; O’Brien, Sarah H.; Núñez, Antonio Rodríguez; Yung, Michael; Truemper, Edward J.; Li, Qin; Li, Simon; Marohn, Kimberly; Randolph, Adrienne G.

doi:10.1097/ccm.0000000000000147

Cited by 59 publications

(69 citation statements)

References 33 publications

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“…En niños, su incidencia parece ser mucho más baja, alrededor del 0,5% de las hospitalizaciones 2,[17][18][19] . Cuando los niños están críticamente enfermos, los factores de riesgo de TVP se incrementan, por lo que se debería esperar que se incrementara su frecuencia, aunque no se dispone de datos fiables al respecto 1 .…”

Section: Discussionunclassified

“…El estudio multicéntrico PROTRACT, que incluyó un número importante de UCIP y pacientes de varios países desarrollados, del que nuestro estudio es un análisis secundario, mostró que existe una gran variabilidad en el uso de la tromboprofilaxis en los niños críticamente enfermos 1 . Dicho estudio ha identificado una serie de características que se asociaron al uso de TPF, como las cardiopatías congénitas, la inmovilidad, la obesidad, la historia previa de trombosis o anastomosis cavopulmonar, la presencia de uno o más CVC y la adolescencia 1 .…”

Section: Discussionunclassified

“…Si bien el porcentaje de pacientes que recibieron TPF fue similar en las UCIP ibéricas e internacionales, las pautas fueron diferentes, de modo que en nuestras UCIP el fármaco más empleado fue la heparina de bajo peso molecular, mientras que en las internacionales lo fue la aspirina, lo que traduce un mejor seguimiento de las recomendaciones actuales en las UCIP ibéricas 1,6 .…”

Section: Discussionunclassified

“…Es posible que a este hecho contribuyan varios factores, como la falta de evidencias pediátricas, la subestimación del riesgo de TVP por los pediatras, los protocolos basados en opiniones de expertos (y, por lo tanto, poco vinculantes) o el caso relativo que en la práctica se hace a algunas recomendaciones 1,6 , así como el temor al riesgo de sangrado al administrar heparina u otros fármacos antiagregantes o anticoagulantes 7,17 . La disponibi lidad de un protocolo formal de tromboprofilaxis debería ser una medida para estandarizar esta pauta.…”

Section: Discussionunclassified

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Thromboprophylaxis in critically ill children in Spain and Portugal

Núñez

Fonte

Faustino

2015

Anales de Pediatría (English Edition)

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Section: Discussionunclassified

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Thromboprophylaxis in critically ill children in Spain and Portugal

Núñez

Fonte

Faustino

2015

Anales de Pediatría (English Edition)

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“…Furthermore, risk factors to identify patients at particularly high risk for thrombosis with the potential to benefit from primary thromboprophylaxis are poorly defined [3,4]. It follows that transplant centers will often adopt practices based on low-level evidence -some protocols are adapted from adult experience, while others are entirely empirical or based on consensus opinion.…”

Section: Introductionmentioning

confidence: 99%

Pediatric transplantation: preventing thrombosis

Robertson

2015

Journal of Thrombosis and Haemostasis

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Summary Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long‐term quality of life. Unfortunately, there remains a general paucity of pediatric‐specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens.

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Model-Guided Decision-Making for Thromboprophylaxis and Hospital-Acquired Thromboembolic Events Among Hospitalized Children and Adolescents

Walker,

French,

Moore

et al. 2023

JAMA Netw Open

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ImportanceRates of hospital-acquired venous thromboembolism (HA-VTE) are increasing among pediatric patients. Identifying at-risk patients for whom prophylactic interventions should be considered remains challenging.ObjectiveTo determine whether use of a previously validated HA-VTE prognostic model, together with pediatric hematologist review, could reduce pediatric inpatient rates of HA-VTE.Design, Setting, and ParticipantsThis pragmatic randomized clinical trial was performed from November 2, 2020, through January 31, 2022, at a single-center academic children’s hospital (Monroe Carell Jr Children’s Hospital at Vanderbilt). All pediatric hospital admissions (aged &lt;22 years) under inpatient status were included and randomized.InterventionAll patients had an HA-VTE probability automatically calculated daily, which was visible to the hematology research team for patients in the intervention group. Patients with an elevated risk (predicted probability ≥2.5%) underwent additional medical record review by the research team to determine eligibility for thromboprophylaxis.Main Outcomes and MeasuresThe primary outcome was rate of HA-VTE. Secondary outcomes included rates of prophylactic anticoagulation and anticoagulation-associated bleeding events.ResultsA total of 17 427 hospitalizations met eligibility criteria, were randomized, and were included in the primary analysis: patients had a median (IQR) age of 1.7 (0 to 11.1) years; there were 9143 (52.5%) female patients and 8284 (47.5%) male patients, and there were 445 (2.6%) Asian patients, 2739 (15.9%) Black patients, and 11 752 (67.4%) White patients. The 2 groups were evenly balanced in number (8717 in the intervention group and 8710 in the control group) and patient characteristics. A total of 58 patients (0.7%) in the control group and 77 (0.9%) in the intervention group developed HA-VTE (risk difference: 2.2 per 1000 patients; 95% CI, −0.4 to 4.8 per 1000 patients; P = .10). Recommendations to initiate thromboprophylaxis were accepted by primary clinical teams 25.8% of the time (74 of 287 hospitalizations). Minor bleeding events were rare among patients who received anticoagulation (3 of 74 [4.1%]), and no major bleeding events were observed during the study period. Among patients randomized to the control group, the model exhibited high discrimination accuracy (C statistic, 0.799, 95% CI, 0.725 to 0.856).Conclusions and RelevanceIn this randomized clinical trial of the use of a HA-VTE prognostic model to reduce pediatric inpatient rates of HA-VTE, despite the use of an accurate and validated prognostic model for HA-VTE, there was substantial reluctance by primary clinical teams to initiate thromboprophylaxis as recommended. In this context, rates of HA-VTE between the control and intervention groups were not different. Future research is needed to identify improved strategies for prevention of HA-VTE and to overcome clinician concerns regarding thromboprophylaxis.Trial RegistrationClinicalTrials.gov Identifier: NCT04574895

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A Multinational Study of Thromboprophylaxis Practice in Critically Ill Children*

Cited by 59 publications

References 33 publications

Thromboprophylaxis in critically ill children in Spain and Portugal

Thromboprophylaxis in critically ill children in Spain and Portugal

Pediatric transplantation: preventing thrombosis

Model-Guided Decision-Making for Thromboprophylaxis and Hospital-Acquired Thromboembolic Events Among Hospitalized Children and Adolescents

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