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Chapter 16 - Prevention of VTE in Children

from Section 2 - Special considerations in pediatric patients

Published online by Cambridge University Press:  18 December 2014

By
Brian R. Branchford  and
Leslie Raffini
Edited by
Neil A. Goldenberg  and
Marilyn J. Manco-Johnson
Brian R. Branchford
Affiliation:
University of Colorado
Leslie Raffini
Affiliation:
University of Pennsylvania Perlman School of Medicine
Neil A. Goldenberg
Affiliation:
The Johns Hopkins University School of Medicine
Marilyn J. Manco-Johnson
Affiliation:
Hemophilia and Thrombosis Center, University of Colorado, Denver
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Summary

Introduction

In-hospital venous thromboembolism (VTE) represents a significant, yet preventable, public health burden, which was recognized in 2008 by the USA Surgeon General’s Call-to-Action [1]. Prophylactic anticoagulation for VTE prevention has been proven to be safe and effective, and has become standard care in hospitalized adults [2,3]. As providers become increasingly aware of the growing problem of VTE in hospitalized children, attention is starting to focus on prevention in this population.

The available data regarding utility and safety of primary prophylaxis is sparse, likely due to the relative infrequency of VTE in children compared to their adult counterparts. Since high-quality evidence in this area is lacking, clinical care is often formulated by expert consensus and extrapolation from adult studies. Two important considerations are clinician awareness of in-hospital VTE, and risk-stratified approaches to prevent unnecessary exposure of low-risk patients to potentially serious side effects. While this is an area expected to evolve greatly, this chapter provides a contemporary review of pertinent background information, risk factors for in-hospital VTE development, and existing recommendations for pharmacologic and non-pharmacologic VTE prophylaxis in children.

Although the incidence of in-hospital VTE is considerably lower in children than adults, it is an increasing problem particularly in pediatric tertiary care hospitals, with potential for severe consequences [4]. Possible explanations for the rising incidence include advances in tertiary care, prolonged survival of medically complex patients, increased utilization of central venous access devices (CVADs), improved imaging sensitivity, and increased awareness. Of children with VTE, 16% to 20% have objectively confirmed pulmonary embolism (PE) [5], and retrospective data from the Hospital for Sick Children indicates a VTE-specific mortality rate of 9% among pediatric PE cases [6]. The risks of long-term pulmonary insufficiency and chronic thromboembolic pulmonary hypertension following PE in children remain undefined.

Type
Chapter
Information
Pediatric Thrombotic Disorders , pp. 207 - 218
Publisher: Cambridge University Press
Print publication year: 2015

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