Venous thromboembolism in paediatrics

Abstract

Explain the risk factors for venous thromboembolism (VTE) in children. Describe the presentation and investigation of VTE. Assess when prophylaxis is required and implement anticoagulation appropriately. Identify when it is safe to perform regional anaesthesia.Venous thromboembolism (VTE) is a condition where a blood clot forms in the deep veins of the arm, groin or leg (deep vein thrombosis [DVT]), which can subsequently travel through the circulation and occlude the pulmonary vasculature (pulmonary embolism [PE]). Cerebral venous thrombosis makes up a small number of VTE in children, but is not covered in this article.VTE is a recognised cause of morbidity and mortality in the hospitalised adult. It is preventable, and there are national guidelines on recognising risk factors and when to initiate prophylaxis. 1 The incidence of VTE in paediatrics is considerably lower than in adults, but it is still identified in the hospitalised child, particularly in tertiary care facilities. Most children diagnosed with VTE have a number of identifiable risk factors. EpidemiologyThe estimated annual incidence of VTE in general paediatrics ranges from 0.14 to 0.21 per 10,000 children. 2 In hospitalised children, the incidence of VTE is five to eight cases per 10,000 hospital admissions. 3 The actual incidence could be significantly higher as the majority of VTE is asymptomatic. VTE can either be provoked (i.e. resulting from underlying conditions or identifiable risk factors) or unprovoked. In hospitalised children, 80% of VTE is provoked, occurring in patients with more than one risk factor. Only 2e8.5% of VTE occurs in children with no risk factorsdmost of them occur later in childhood and adolescence. This is in contrast to the hospitalised adult, where up to 50% of VTE occurs in the absence of risk factors. 4 There are two peaks in the overall incidence: one in infants less than 2 yrs old and the other in adolescence. 4 In adolescents, the risk factors of smoking, obesity, pregnancy and the combined oral contraceptive pill are relevant and need to be incorporated into risk assessments. Adolescent females are twice as likely to develop VTE than males. 5 Stephanie Jinks FRCA is a locum consultant anaesthetist at Great Ormond Street Hospital for Children NHS Foundation Trust. She has special interests in medical education and quality improvement. Amaia Arana FRCA is a consultant paediatric anaesthetist at Leeds Teaching Hospitals NHS Trust with a specialist interest in pain management. She was a member of the Association of Paediatric Anaesthetists Guidelines Development Group for the prevention of perioperative venous thromboembolism in children. Key pointsEighty per cent of venous thromboembolism (VTE) in paediatrics occurs in those with identifiable risk factors. VTE is associated most commonly with central venous catheters. Adolescents are at an increased risk of VTE, and this risk should be assessed. Prophylaxis can be mechanical and pharmacological. Low-molecular-weight heparin is used for treatment and prophylaxis. Ne...

Pressure Injuries Related to the Use of Compression Stockings in Pediatric Surgical Patients

“…Patients who undergo a vaginoplasty are severely activity-restricted to protect the surgical site. Postsurgical adolescent patients with prolonged immobility and the use of oral contraceptives may be at an increased risk for deep vein thrombosis (Jinks & Arana, 2019). Approximately 80% of pediatric patients who develop a VTE have one or more identifiable risk factors (Jinks & Arana, 2019).…”

“…KEY WORDS: compression stocking, hospital-acquired pressure injuries, pediatric, surgery V enous thromboembolism (VTE) is a medical condition where a blood clot forms in the extremities or groin (Jinks & Arana, 2019).…”

“…VTE risk factors in the pediatric population include oral contraceptive use, obesity, smoking, and/or pregnancy. It is estimated that the rate of VTE presenting in pediatric patients is anywhere between 0.14 and 0.21 per 10,000 children (Jinks & Arana, 2019).…”

“…Venous thromboembolism (VTE) is a medical condition where a blood clot forms in the extremities or groin (Jinks & Arana, 2019). Common risk factors for VTE include postsurgical immobility, family history, obesity, or oral contraceptive use (Murphy et al, 2020).…”

“…Common interventions for pediatric prevention of VTE include early ambulation and use of compression stockings or sequential compression devices and pharmacological interventions (Jinks & Arana, 2019; Kerlin et al, 2014; Murphy et al, 2020). Pediatric surgical nurses should be knowledgeable about prevention strategies and associated risk factors.…”