Venous thromboembolism in pediatric trauma patients: Ten‐year experience and long‐term follow‐up in a tertiary care center

Abstract

TBI therapy is closely linked to the development of DVT. Coagulopathy on admission is associated with hypercoagulability in the postinjury period, suggesting a patient phenotype with systemic coagulation dysregulation. Treatment was not associated with improved VTE outcomes, suggesting that pediatric protocols should emphasize VTE prevention and prophylaxis strategies.

Single-Center Use of Prothrombin Complex Concentrate in Pediatric Patients

“…Previous pediatric studies focusing on the rate of thrombosis in critically ill children reported that the incidence in severely injured patients can be as high as 13.8% with a significantly lower incidence in nontrauma patients. [24][25][26][27][28] Compared with these previous reports, the DVT rate in our cohort was high, but no sequelae Abbreviations: 4F-PCC, four-factor prothrombin complex concentrate; FFP, fresh frozen plasma; INR, international normalized ratio; TACO, transfusion-associated circulatory overload; TRALI, transfusion-related acute lung injury. of the localized thrombotic event such as pulmonary embolism was noted.…”

Trauma-Induced Coagulopathy in Children

“…Overall, VTE occurs significantly less frequently in children compared with adults, but the risk can be substantial in high-risk groups. 85 Many studies identify rates of VTE in pediatric trauma patients ranging from 4 to 10% [86][87][88][89] ; however, higher risk groups may have rates in the range of 10 to 25%. 87,90 The following risk factors for VTE in pediatric trauma patients have been identified: increasing age, injury severity, indwelling central venous catheters, total parenteral nutrition, immobility, pressor support, TBI, and AHT.…”

“…87,90 The following risk factors for VTE in pediatric trauma patients have been identified: increasing age, injury severity, indwelling central venous catheters, total parenteral nutrition, immobility, pressor support, TBI, and AHT. 86,88,[91][92][93] The effectiveness of pharmacological prophylaxis against VTE in children is largely unknown and is assumed to be similar to that in adults or postpubertal adolescents. The Eastern Association for the Surgery of Trauma published guidelines in 2016 that suggest the use of pharmacological prophylaxis in children aged 15 years and older with low bleeding risk and younger than 15 years but postpubertal with an injury severity score of > 25.…”

Viscoelastic monitoring in trauma resuscitation

“…[147][148][149][150] In line with this concern, application of VEM platforms to identify hypercoagulable trauma patients has been undertaken. 108,[151][152][153][154][155] Elevated TEG MA on admission has been correlated with increased incidence of pulmonary embolism in a retrospective observational study. 151 TEG MA greater than 65 mm was found to independently predict pulmonary embolism with direct correlation between further increases in MA and risk of such an event in a prospective study, 152 and similar correlation has been noted prospectively for elevated TEG MA and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) in extremity trauma.…”

“…In injured children, risk of VTE in general is substantially lower than in adults, though high risk populations include those with traumatic brain injury and bimodal age distribution (age < 3 years and age > 13 years). 108,155 A TEG MA ≥ 65 mm is found in approximately one third of all pediatric trauma patients, though an association of admission TEG MA with future VTE has not been established. In contrast, admission FSD (LY30 ≤ 0.8%) is common and has been associated with subsequent development of deep vein thrombosis.…”