Thrombosis in Children

Abstract

Thrombosis in children is becoming more prevalent due to increased awareness of these issues in the pediatric population and advances in medicine. Management of affected children are challenging due to differences in their hemostatic system compared with adults. Prospective, controlled trials for management/treatment of children with thrombosis are lacking. Many of the available guidelines for treatment of thrombosis in children are extrapolated from adult data and do not account for the uniqueness of the pediatric hemostatic system, although more research and data are becoming available. This review will focus on children over 1 year of age, including adolescents, looking at the etiology of thrombosis, diagnosis, management options, and any associated complications in this pediatric population.

Pediatric Thrombotic Events

“…13,14 In our study 4.5% were heterozygous for factor V Leiden within the quoted population rate of 2% to 7%. 15 This questions the influence that this mutation has had on thrombotic episodes in our study population.…”

A Diagnostic Approach to a Child with Thrombosis

“…FVIII:C = Activity (>90th percentiles); FVIII:Ag = antigen (>90th percentile); NA = not applicable; R = random effect model. 1 Heterozygote trait. 2 Including FV Leiden, Prothrombin G20210A mutation, Lp(a) (>30 mg/dl), antithrombin deficiency, protein C and/or protein S deficiency.…”

“…This is called activity-induced thrombosis or Paget-Schroetter syndrome [26]. In the lower extremity, a left-sided iliac vein outflow obstruction can result in an increased risk of VTE due to an intimal hypertrophy of the left common iliac vein as a consequence of its compression by the overlaying right common iliac artery, the so-called May-Thurner syndrome [1].…”

“…Newborns and adolescents are the two age groups with the greatest incidence of VTEs [1][2][3]. Children <1 year of age represent the greatest risk group for ATEs [4].…”

Venous Thrombosis

“…Advantages include that it is safe, painless, and portable. Doppler ultrasound is recommend ed to assess for DVT of the lower limb, periph eral upper limb, axillary, subclavian and internal jugular veins [5,6]. The central intrathoracic ve nous system is contained within the bony tho rax, making Doppler ultrasound a less sensitive tool for diagnosis of DVT in this anatomical lo cation.…”