Use of Pharmacologic Prophylaxis Against Venous Thromboembolism in Hospitalized Injured Children

Mahajerin, Arash; Petty, John K.; Hanson, Sheila J.; Shabanova, Veronika; Faustino, E. Vincent S.

doi:10.1097/mph.0000000000002167

Cited by 6 publications

(4 citation statements)

References 37 publications

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“… 20 Similarly, in 2 studies looking at pharmacologic TP in pediatric trauma patients aged 0 to 18 years, 1.1% and 6.2% of patients were given VTE prophylaxis, respectively. 21 , 22 Our study did include more current data (up to 2021), and the use of TP has likely increased in other pediatric and adolescent populations as well given the increasing recognition of VTE as preventable harm in children’s hospitals. 18 …”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients

2023

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Patients with sickle cell disease (SCD) are predisposed to a hypercoagulable state. Despite the increased risk of venous thromboembolism in the SCD population, there is limited evidence available to guide thromboprophylaxis (TP) practices in these patients. This study aimed to assess the use of pharmacologic and nonpharmacologic TP in adolescent patients with SCD using the Pediatric Health Information System (PHIS). We hypothesized that TP was increasingly used in hospitalized adolescent patients with SCD. The study included patients with SCD aged 13 to 21 years, admitted to a PHIS hospital between 1 January, 2010, and 30 June, 2021. A total of 7202 unique patients consisting of 34 094 unique admissions were included for analyses. Pharmacologic or mechanical TP was used in 2600 (7.6%) admissions, with 3.6% of admissions (n = 1225) receiving pharmacologic prophylaxis and 4.3% (n = 1474) receiving mechanical prophylaxis. Pharmacologic TP increased in use from 1.3% of admissions in 2010 to 14.4% in the first half of 2021. Enoxaparin was the most commonly prescribed anticoagulant, used in 87% of admissions in which pharmacologic TP was used. The use of prophylactic direct oral anticoagulants was first documented in 2018 and increased to 25% of admissions with pharmacologic TP by 2021. This study demonstrates a steady increase in TP use in adolescent patients with SCD admitted to the hospital. Prospective cohort studies are needed to determine VTE risk factors in adolescents and children with SCD and the efficacy and safety of prophylactic regimens.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients

2023

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“…Among infants in our study, rates of CADVT generally decreased across periods as the starting dose of enoxaparin was increased. Studies in children suggest that prophylaxis is most effective when started within 3 days after insertion of the CVC (24). Differences in time to start prophylaxis unlikely impacted the rates of CADVT in our study because median times across the 3 periods were within 3 days of insertion of the CVC.…”

Section: Discussionmentioning

confidence: 99%

“…Among infants in our study, rates of CADVT generally decreased across periods as the starting dose of enoxaparin was increased. Studies in children suggest that prophylaxis is most effective when started within 3 days after insertion of the CVC (24). Differences in time to start prophylaxis , protocol implementation (period 2; January 2016-January 2017), and protocol revision (period 3; February 2017-December 2018).…”

Section: At the Bedsidementioning

confidence: 99%

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Centers

Hege

Nitu

et al. 2022

Pediatric Critical Care Medicine

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The effectiveness of pharmacologic prophylaxis against catheterassociated thrombosis in children is unclear. We evaluated the compliance and outcomes associated with a prophylactic enoxaparin protocol in postoperative cardiac children. DESIGN:The protocol was implemented as a quality improvement initiative and then analyzed using interrupted time series method. Data collected from November 2014 to December 2018 were divided into preprotocol (period 1), protocol implementation (period 2), and protocol revision (period 3). SETTING:A 12-bed academic pediatric cardiac ICU. PATIENTS:Children less than or equal to 18 years old with congenital heart disease admitted postoperatively with central venous catheter in situ for greater than or equal to 1 day. INTERVENTIONS:Before 2016, prophylactic enoxaparin was administered according to physician preference. In January 2016, an enoxaparin protocol was implemented with a goal anti-Xa range of 0.25-0.49 international units/mL. Protocol was revised in February 2017 to increase the starting dose by 25% for infants less than 1 year old. MEASUREMENTS AND MAIN RESULTS:We analyzed 780 hospitalizations from 636 children. Median percentage of catheter-days on prophylactic enoxaparin was 33% (interquartile range [IQR], 23-47%), 42% (IQR, 30-51%), and 38% (IQR, 35-52%) in periods 1-3, respectively. Percentage of catheter-days on enoxaparin showed immediate increase of 90% (95% CI, 17-210%) between periods 1 and 2 and sustained increase of 2% (95% CI, 0.3-4%) between periods 2 and 3. Median rates of thrombosis per 1,000 catheter-days were 5.8 (IQR, 0-9.3), 3.8 (IQR, 0-12), and 0 (IQR, 0-5.3) in periods 1-3, respectively. Rate of thrombosis showed immediate decrease of 67% (95% CI, 12-87%) between periods 1 and 2 and sustained decrease of 11% (95% CI, 2-18%) between periods 1 and 3. CONCLUSIONS:The temporal association between increase in percentage of catheter-days on enoxaparin and decrease in rate of thrombosis suggests the effectiveness of prophylactic enoxaparin. KEY WORDS: anticoagulation agents; central venous catheter; intensive care units; pediatric; venous thrombosis C hildren with congenital heart disease (CHD) admitted postoperatively to the cardiovascular ICU (CVICU) are at high risk of venous thromboembolism (VTE) (1, 2). Placement of central venous catheter (CVC) constitutes an important risk factor for VTE (3). Peripherally inserted central catheter (PICC)

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“…The combined data, which had low certainty of evidence, showed no conclusive effect of LMWH on the rates of CADVT [29 ▪▪ ]. Guidelines exist for DVT prophylaxis in select pediatric populations but likely because of the historic lack of strong evidence, few children actually receive prophylaxis, and those who do are in poor concordance with the guidelines [30 ▪ ].…”

Section: Prevention Of Central Venous Catheter-associated Deep Vein T...mentioning

confidence: 99%

Central venous catheter-associated deep vein thrombosis in critically ill pediatric patients: risk factors, prevention, and treatment

Johnson

Faustino

2022

Current Opinion in Pediatrics

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Purpose of review Central venous catheter (CVC) placement and ICU admission are the two most important risk factors for pediatric deep vein thrombosis. The optimal prevention and treatment strategies for CVC-associated deep vein thrombosis (CADVT) are unclear, but recently, seminal studies have been published. This review aims to summarize the recent literature on CADVT in critically ill children. Recent findings Recent publications focused on three themes: risk factors, prevention, and treatment of CADVT. Newly identified risk factors for CADVT relate to Virchow's triad of hemostasis, blood vessel injury, and hypercoagulability. New risk prediction models have moderately good accuracy in predicting CADVT. Though previous data on pharmacologic CADVT prophylaxis was equivocal, recent studies indicate that low-molecular-weight heparin may be effective in preventing CADVT, particularly in critically ill children. Finally, new studies suggest that direct oral anticoagulants and shorter treatment times are noninferior to traditional agents and treatment durations in the treatment of CADVT. Summary Recent research suggests new ways to accurately identify children at high risk of CADVT, effectively prevent CADVT, and optimize CADVT treatment. Future research should focus on understanding the pathobiology of CADVT formation, prevention, and treatment in critically ill children.

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Use of Pharmacologic Prophylaxis Against Venous Thromboembolism in Hospitalized Injured Children

Cited by 6 publications

References 37 publications

Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients

Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Central venous catheter-associated deep vein thrombosis in critically ill pediatric patients: risk factors, prevention, and treatment

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