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Review
. 2017 Sep 21;130(12):1402-1408.
doi: 10.1182/blood-2017-04-742320. Epub 2017 Aug 3.

How I treat pediatric venous thromboembolism

Guy Young  1
Affiliations
Review

How I treat pediatric venous thromboembolism

Guy Young. Blood. .

Abstract

The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly over the past decade in part as a result of increased recognition of this serious disorder but more so because of the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking, considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, in comparison with adults, this remains a relatively rare disorder, and as such, large-scale clinical trials have not been completed, rendering management decisions to be based on extrapolation from adult data and the experience of the treating physician. Clearly, both are fraught with problems. Thus, day-to-day management remains more art than science until such time that the results from clinical trials (many of which are under way) become available. This edition of "How I Treat" describes the author's experience in managing 3 common scenarios that one may encounter in pediatric thrombosis and suggests a logical approach to such situations. Furthermore, the author provides 3 algorithms to help guide management decisions.

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Conflict of interest statement

Conflict-of-interest disclosure: G.Y. participates in the steering committees for rivaroxaban and edoxaban, for which he has received financial compensation.

Figures

Figure 1.
Figure 1.
Algorithm for anticoagulation selection by age. Of note, because direct oral anticoagulants are not yet in wide clinical use, they are not included in this algorithm. ICU, intensive care unit; LMWH, low-molecular-weight heparin.
Figure 2.
Figure 2.
A decision-tree algorithm for catheter-related venous thrombosis. DVT, deep vein thrombosis.
Figure 3.
Figure 3.
A decision-tree algorithm for idiopathic lower-extremity DVT. TPA, tissue plasminogen activator.
See this image and copyright information in PMC

References

    1. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-1008. - PubMed
    1. Mahajerin A, Branchford BR, Jaffray J, et al. Children’s Hospital-Acquired Thrombosis database (CHAT): a multi-institutional database for prospective identification of independent risk factors [abstract]. Blood. 2015;126(23). Abstract 1111.
    1. Young G. Anticoagulants in children and adolescents. Hematology Am Soc Hematol Educ Program. 2015;2015:111-116. - PubMed
    1. Zenz W, Arlt F, Sodia S, Berghold A. Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years. Semin Thromb Hemost. 1997;23(3):321-332. - PubMed
    1. Monagle P, Chan AK, Goldenberg NA, et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(2 suppl):e737S-e801S. - PMC - PubMed

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