Venous Thromboembolism in Children: Is It Preventable?

Abstract

The incidence of venous thromboembolism (VTE) in children is increasing. Hospitalized infants and adolescents are at highest risk, and most individuals who have VTE have multiple thrombotic risk factors. The presence of a central venous catheter (CVC) is the most frequent risk factor for childhood thrombosis. Childhood VTE has significant consequences in relation to the thrombotic event and the anticoagulant therapy used for its treatment. Identification of the most prevalent risk factors for VTE, particularly among adolescents, has moved the focus toward prevention of thrombosis. Risk assessment models have been developed to identify individuals who are at higher risk with a view to employing preventative strategies such as mechanical and chemical thromboprophylaxis (TP). There is currently little evidence to support the efficacy of such strategies for preventing either CVC-associated thrombosis or thrombosis at other sites. In addition, there are concerns about adverse consequences of mechanical and chemical TP in a population where the overall incidence of VTE remains low.

Hip Replacement Surgery in 14-Year-Old Girl with Factor V Deficiency: Haemostatic Treatment and Thromboprophylaxis

“…There are no clear references regarding the thrombotic risk in adolescence under orthopaedic surgery and no one in subjects with FV deficiency. The prevalence of venous and arterial thrombosis is increasing in the paediatric and adolescent population [10, 11]. Although some authors describe as idiopathic up to 37% of cases of venous thrombosis in adolescent [12], others suggest the presence of two or more vascular risk factors in 81% of the adolescents with a thrombotic event [13].…”

Advances in predicting venous thromboembolism risk in children

“…There is a dramatic increase in the paediatric VTE incidence rate rising up to 58 cases per 10 000 hospital admissions in the United States in 2007 (Raffini et al , ). This increase is possibly due to thrombosis as a consequence of successful medical or surgical intervention for childhood disorders, such as prematurity, malignancy and congenital heart disease, as well as the increased use of central venous catheters (CVC) and progress in VTE diagnosis (Biss, ; Kenet et al , ; van Ommen & Nowak‐Göttl, ). The consequences of VTE for paediatric patients are significant, including lack of thrombus resolution in 50% of cases, post‐thrombotic syndrome in about 30% of cases, chronic pulmonary insufficiency, pulmonary hypertension and mortality rate of 2%, rising to 9% among paediatric pulmonary embolism cases (Branchford et al , ; Meier et al , ; Kenet et al , ).…”

“…There is consensus that VTE risk assessment markedly reduces the rate of VTE in hospitalised adults (Biss, ). Thus, VTE risk assessment in adults has become standard of care, e.g.…”

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

“…Although it is rare, the occurrence of VTE can be associated with significant morbidity in children. Complications occurring most commonly after VTE include post-thrombotic syndrome (estimated incidence of 26% after DVT in one systematic review),21 22 and increased risk of mortality (relative risk of 6.27 compared with patients without VTE,8 21 with mortality related to VTE estimated at 2.2%) 2. Furthermore, among pediatric patients treated after trauma, VTE has been linked to higher costs and longer hospital lengths of stay 10 16…”