Venous thrombosis in children

Abstract

Summary. Venous thromboembolic (VTE) events are being increasingly diagnosed in systemic and cerebral vessels in children. Systemic VTE are increasing in children as a result of therapeutic advances and improved clinical acumen in primary illnesses that previously caused mortality. The epidemiology of systemic VTE has been studied in international registries. In children older than 3 months, teenagers are the largest group developing VTE. The most common etiologic factor is the presence of central venous lines. Clinical studies have determined the most sensitive diagnostic method for diagnosing upper system VTE are ultrasound for jugular venous thrombosis and venography for intrathoracic vessels. However, the most sensitive diagnostic methods for lower system VTE and pulmonary embolism (PE) have not been established. Treatment studies for VTE consist of inadequately powered randomized controlled trials or prospective cohort studies. The long‐term outcome of systemic VTE, post‐thrombotic syndrome, has been reported in children. Cerebral sinovenous thrombosis (CSVT) is becoming increasingly diagnosed in children due to the recognition of the associated subtle clinical symptoms and improved cerebrovascular imaging. The etiology of CSVT includes thrombophilia, head and neck infections, and systemic illness. Estimates of the incidence and outcome of childhood CSVT have recently become available through the Canadian Pediatric Ischaemic Stroke Registry. Clinical studies have not yet been carried out in children to determine the best method of diagnosis or treatment. There have only been case‐series studies carried out in the treatment of CSVT. Properly designed clinical trials are urgently required in children with systemic VTE/PE and CSVT to define the best methods of diagnosis, treatment and long‐term management.

Optimal management of venous thromboembolism in adolescent and young adult oncology patients

“…Recognizing that the overall prevalence of asymptomatic VTE in children with cancer is reported to be as high as 40%, 37 modalities used to diagnosis VTE in pediatrics include ultrasound, venography, computed tomography, and magnetic resonance imagining. 38 The role of D-dimer as a predictive tool in the diagnosis of VTE has not been validated in pediatric patients. 39 On the basis of the higher incidence of upper extremity VTE in the pediatric oncology population, generally associated with the use of a central venous catheter, an evidence-based recommendation for the detection of upper venous system thrombosis is available.…”

“…39 On the basis of the higher incidence of upper extremity VTE in the pediatric oncology population, generally associated with the use of a central venous catheter, an evidence-based recommendation for the detection of upper venous system thrombosis is available. 38 The PARKAA study concluded that both a venogram and ultrasound in combination were needed since venography was more sensitive than ultrasound in detecting intrathoracic (central) VTE, but ultrasound was more sensitive for internal jugular and axillary VTE. 40 There are limited data supporting the use of three-dimensional gadolinium-enhanced magnetic resonance imaging for detecting pediatric upper venous thrombosis; however, there have been no comparative studies with currently recommended ultrasound and venography to establish improved efficacy.…”

The KIDS SAFE Checklist for Pediatric Intensive Care Units

“…52 Thrombosis is also a common complication of central venous catheters in critically ill patients; in prospective studies, 53,54 the reported incidence has been up to 40%. Current treatment recommendations suggest short-term prophylactic anticoagulation as an option for children who are in high-risk situations (immobility, major surgery, or trauma) and have 3 or more acquired risk factors.…”

“…Current treatment recommendations suggest short-term prophylactic anticoagulation as an option for children who are in high-risk situations (immobility, major surgery, or trauma) and have 3 or more acquired risk factors. 52 The risk-benefit ratio should be considered for each patient. 52 The goal of this element of the checklist is to highlight the need to consider each patient's individual risk factors for venous thromboembolic events.…”

“…52 The risk-benefit ratio should be considered for each patient. 52 The goal of this element of the checklist is to highlight the need to consider each patient's individual risk factors for venous thromboembolic events. Decisions on prophylaxis are left to clinicians, with the aim of reducing these sometimes preventable adverse events.…”