Advances in predicting venous thromboembolism risk in children

Abstract

Paediatric venous thromboembolism (VTE) is a rare disorder but a rising incidence has been observed in recent years, due to improved VTE diagnosis and increased use of central venous catheters in the treatment of severe diseases. Risk assessment strategies are well established for adult patients, however, similar guidelines for paediatric patients are largely lacking. Several risk prediction tools have been reported in recent literature, which make use of established risk factors to assess VTE risk in paediatric subgroups, such as hospitalised children, cancer-diagnosed children and paediatric trauma patients. Although these models suffer several limitations regarding their study size and heterogeneous selection of predictor variables, they offer potential for improving the thromboprophylaxis management in these children. Here, we give an overview on recently reported risk prediction models for paediatric VTE.

Serratia marcescens Sepsis in a Child with Deep Venous Thrombosis – A Case Report

“…In our patient, the heterozygous state for Factor V Leiden increases the chance of developing thrombosis by four to eight times. The recurrence rate of VTE remains high, despite the administration of anticoagulant therapy, being of approximately 7% at six months, with a mortality rate of 6% for DVT and 12% for PE within one month (16). Fortunately, after showing slow progress, in the current patient, complete permeabilisation was achieved after twelve months of treatment, and he was, at the time of the writing of this case report, recurrence-free.…”

“…Additionally, he had external risk factors, having had an appendectomy two weeks before the diagnosis of DVT and subsequent bed rest plus infection. In comparison to adults, where up to 50% of the first VTE episodes have an idiopathic underlying condition, VTE in children has a multifactorial pathogenesis, and almost 90% of these cases have at least two risk factors for thrombosis at the time of the event (16)(17)(18).…”

Hemostatic Balance in Severe Trauma

“…The incidence of VTE in pediatric trauma patients is < 0.5% (48)(49)(50). This is in sharp contrast to the adult trauma patient population where the estimated incidence is as high as 20-58% without appropriate thromboprophylaxis (47). However, there is a paucity of evidence for standardized VTE screening in children and thus children are monitored for VTEs less frequently so the actual incidence may differ.…”

“…or acquired risk factors for thrombosis, multiple disease-or treatment-related risk factors contribute to VTE (47). The incidence of VTE in pediatric trauma patients is < 0.5% (48)(49)(50).…”

Improving venous thromboembolism management in children undergoing surgery

“…Pediatric VTE, while less common than in adults, is being diagnosed more frequently in hospitalized children, is often preventable, and is associated with significant morbidity, mortality, and cost . However, there have been few comprehensive evidence‐based or best‐practice guidelines for perioperative VTE prevention in this population.…”