Recommendations from the ICM-VTE: Pediatric

Abstract

The ICM-VTE Pediatric Delegates* 1 -Are the risk factors for VTE following orthopaedic procedures different between children and adults?Response/Recommendation: Many risk factors for venous thromboembolism (VTE) in pediatric orthopaedic patients are similar to those in adults. These include older age (adolescents), trauma, malignancy, certain infections, clotting disorders and a personal or family history of VTE. However, certain VTE risk factors reported in adult literature (e.g., smoking) may be less prevalent in children, and vice versa (e.g., congenital thrombophilia).Strength of Recommendation: Moderate.Delegates vote: Agree 100.00% Disagree 0.00% Abstain 0.00% (Unanimous Strong Consensus).Rationale: VTE is a common complication in adults undergoing orthopaedic surgery, and the risk factors for this condition are well established. In contrast, VTE is extremely rare in pediatric orthopaedic patients 1 . The incidence of VTE has been reported at 0.0515% for pediatric patients admitted following elective orthopaedic procedures 2 . The incidence rises to 0.10% when non-elective procedures are included 3 , and peaks at 0.68% in trauma patients 4,5 .Epidemiologic data has demonstrated that the incidence of pediatric VTE is bimodal, with the highest incidence rates in infants and adolescents 6 . Pediatric patient populations with certain conditions are at an increased risk for VTE. These conditions include: congenital heart disease, nephrotic syndrome, prior splenectomy in patients with hemolytic anemia, colectomy in patients with inflammatory bowel disease, congenital thrombophilia and other genetic or metabolic diseases 7 . Catheter-related thrombosis is the single most common cause of pediatric VTE [8][9][10] . Central venous catheters (CVC) may directly damage the vessel wall, increase blood flow turbulence, introduce substances that damage endothelial cells, and contain thrombogenic materials.Due to the complex pathophysiology of pediatric patients, pediatric orthopaedic patients have different risk factors for VTE compared to their non-orthopaedic counterparts 11,12 . Currently, literature suggests that the most common risk factors for VTE in pediatric orthopaedic patients are adolescent age, trauma, infection, cancer, clotting disorders, and a personal or family history of VTE 9,11,13 .Pediatric trauma patients are an identifiable subgroup that is at highest risk of VTE 14 . However, the risk of VTE is not uniform across age groups, with most cases occurring in children aged 10 -15 years (0.1%). In one study, Guzman et al. 4 , found that younger pediatric trauma patients (i.e., under 10 years) had a much lower risk of VTE compared to adolescents aged 13 -15. Moreover, older adolescent patients (> 16 years) physiologically resembled adults, and had similar VTE frequencies to the adult population 4,8,11,[15][16][17][18] .Another specific pediatric orthopaedic population at increased risk of VTE is children with musculoskeletal infections such as osteomyelitis or septic arthritis, especially if the infectin...

Venous thromboembolism in orthopedic surgery: Global guidelines

“… 106 However, the incidence of VTE increases significantly to 0.68% in pediatric trauma patients, making them the subgroup with the highest risk. 107 …”

International consensus on prevention of venous thromboembolism in patients after orthopedic interventions

“…У березні 2022 року опубліковано нові міжнародні рекомендації щодо профілактики венозної тромбоемболії в пацієнтів після великих ортопедичних утручань (Recommendations from the International Consensus Meeting on Venous Thromboembolism) [1][2][3][4][5][6][7][8][9][10]. Передумовою для створення цього консенсусу послужила недосконалість наявних даних і рекомендацій щодо профілактики тромбоемболії в періопераційному періоді.…”

“…Рекомендації містять розділ зі загальними підходами тромбопрофілактики після ортопедичних утручань [1] та спеціалізованими, зокрема: у разі хірургії верхньої кінцівки та зап'ястка [2], плеча або ліктя [3], стопи або гомілки [4], стегна або коліна [5], хребта [6], за умов онкології [7], у випадку операцій у дітей [8], після ушкоджень [9] і спортивних травм [10].…”