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

Abstract

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.

Predisposing Factors and Incidence of Venous Thromboembolism among Hospitalized Patients with Sickle Cell Disease

“…Several studies have explored potential risk factors contributing to VTE in SCD. A comprehensive study in 2020, which included 1193 pediatric and adult SCD patients, identified factors such as a lower estimated glomerular filtration rate, hydroxyurea use, HbSS/Sβ0 genotype, elevated white blood cell (WBC) counts, and Hb level as independent risk factors associated with VTE [32]. A 2021 study from Oman on 102 SCA patients (68 with VTE and 34 controls) highlighted high WBC count, serum lactate dehydrogenase (LDH), bilirubin, C-reactive protein (CRP), and low hemoglobin and hemoglobin F levels as significant VTE risk factors [6].…”

”Comment on: [ Role of regional anesthesia in patients with acute sickle cell pain: A scoping review].

“…Using the slicer-dicer tool in our institutional electronic health care record (EPIC Systems, Verona, WI) we found a staggeringly high percentage of patients admitted for sickle cell crisis with a pre-admission use of anticoagulants (see Figure 1). In fact, the trend in the use of pharmacologic thromboprophylaxis in hospitalized adolescent patients with SCC steadily increased in the last decade owing to the increased risk of VTE (6,7). Multiple sites of pain a patient with SCC can present with might be another factor that limits the effective use of RA techniques in these patients (8).…”

Comment on: Role of regional anesthesia in patients with acute sickle cell pain: A scoping review

“…In fact, the trend in the use of pharmacologic thromboprophylaxis in hospitalized adolescent patients with SCC steadily increased in the last decade, owing to the increased risk of VTE. 6,7 Often, SCC presents withmultiple non-contiguous sites of pain which might be another factor that limits the effective use of RA techniques in these patients. 8 To add to this complexity, patients, especially children with SCD are at increased risk of bloodstream infections 9 where the prevalence of bacteremia in febrile patients with SCD can be as high as 1.9%.…”