Diagnosis of Venous Thromboembolism in Children

Male, Christoph; Kuhle, Stefan; Mitchell, Lesley

doi:10.1055/s-2003-42588

Cited by 44 publications

(9 citation statements)

References 95 publications

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“…Most importantly, reported incidences of CVC-VTE depend on clinical awareness and the diagnostic test used to investigate for VTE. Incidences of CVC-VTE in children identified through clinical diagnosis were 4–13% (5–7), through venous ultrasonographic screening were 1–44% (5), and screening via venography were 13–50% (6–8). Table 1 highlights CVC characteristics that may lead to an increased VTE rate.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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The use of central venous catheters (CVCs) in children is escalating, which is likely linked to the increased incidence of pediatric venous thromboembolism (VTE). In order to better understand the specific risk factors associated with CVC-VTE in children, as well as available prevention methods, a literature review was performed. The overall incidence of CVC-VTE was found to range from 0 to 74%, depending on the patient population, CVC type, imaging modality, and study design. Throughout the available literature, there was not a consistent determination regarding whether a particular type of central line (tunneled vs. non-tunneled vs. peripherally inserted vs. implanted), catheter material, insertion technique, or insertion location lead to an increased VTE risk. The patient populations who were found to be most at risk for CVC-VTE were those with cancer, congenital heart disease, gastrointestinal failure, systemic infection, intensive care unit admission, or involved in a trauma. Both mechanical and pharmacological prophylactic techniques have been shown to be successful in preventing VTE in adult patients, but studies in children have yet to be performed or are underpowered. In order to better determine true CVC-VTE risk factors and best preventative techniques, an increase in large, prospective pediatric trials needs to be performed.

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Section: Resultsmentioning

confidence: 99%

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

2017

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“…Ultrasound is the most common imaging modality employed to diagnose neonatal VTE, although venography is considered the reference standard for diagnosis of VTE (23). In the Canadian VTE registry study, Doppler ultrasound was used to diagnose 67% of the venous thromboses (11).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The availability of Doppler ultrasound as well as its non-invasive nature makes it an attractive diagnostic modality. However, it is operator dependent and its sensitivity and specificity decline when evaluating intrathoracic vessels as well as the iliac vessels or if the patient is edematous or has interfering skin abnormalities (23). A prospective study aimed at determining the incidence of asymptomatic venous thromboses associated with UVCs found that Doppler echocardiography was less sensitive than contrast venography (24).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Further, the Prophylactic Antithrombin Replacement in Kids with ALL treated with Asparaginase study recommended a combination of ultrasound and venography to investigate upper extremity, line associated VTE (25). Venography is not often employed, though, given its invasive nature, technical demands, and radiation exposure (23). CT or MRI can be employed to evaluate the intrathoracic venous system for thromboses (26).…”

Section: Clinical Presentationmentioning

confidence: 99%

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Neonatal Venous Thromboembolism

Haley

2017

Front. Pediatr.

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Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE), and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the coagulation proteins as well as unique pharmacokinetics must also be taken into consideration when recommending VTE treatment. In this review, epidemiology of neonatal VTE, pathophysiology of neonatal VTE with particular attention to the developmental hemostatic system, diagnostic evaluations of neonatal VTE, and treatment guidelines for neonatal VTE will be reviewed.

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“…Most of these episodes were clinically silent. In the PARKAA study (Prophylactic Antithrombin Replacement in Kids with ALL Treated with Asparaginase), ultrasound was demonstrated to be insensitive compared to venography for CVL-related intrathoracic thrombosis, but more sensitive for jugular vein thrombosis [11], suggesting that a combination of ultrasound and venograpy imaging is required for accurate diagnosis of CVL-related thrombosis in the upper venous system [12]. In the future, magnetic resonance imaging may become a noninvasive alternative for invasive venography for the detection of CVL-related thrombosis [13, 14].…”

Section: Frequency Of Cvl-related Thrombosismentioning

confidence: 99%

Central Venous Line-Related Thrombosis in Children

Revel‐Vilk

2006

Acta Haematol

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Central venous lines are used in critically ill children and in children with chronic conditions for the administration of intravenous therapy, such as fluids, medications, total parenteral nutrition and blood products. Although the use of central venous lines has greatly improved the quality of care in these children, these catheters may cause serious mechanical, infectious and thrombotic complications. The reported frequency of catheter thrombosis in children is low as 5% in studies including only symptomatic cases and high as 50% in studies where patients are systematically screened for catheter-related thrombosis. The risk factors for catheter-related thrombosis in children are associated with the methods used for catheter insertion and with individual patient characteristics, underlying diagnosis and treatment. The management of catheter-related thrombosis is largely dependent on the requirement of the catheter. If no longer required or nonfunctioning the catheter should be removed. If access is still required and the catheter is functioning, treatment with anticoagulation is recommended in the absence of contraindications. The management of radiographically detected asymptomatic thrombosis in children is less clear. Clinical studies of prophylaxis for catheter-related thrombosis are inconclusive and no definitive recommendations for prophylaxis in adults or in children with central venous thrombosis can be made. Properly designed studies are needed to assess the role of prophylactic anticoagulation for preventing catheter-related thrombosis.

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Diagnosis of Venous Thromboembolism in Children

Cited by 44 publications

References 95 publications

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism

Neonatal Venous Thromboembolism

Central Venous Line-Related Thrombosis in Children

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