Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

Abstract

Background: Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as "asymptomatic," "incidental," or "clinically silent/occult" VTE. Objective: To understand the epidemiology, management, and outcomes of uVTE in children. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). Results: Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I 2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%-24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non-CVL settings included post-spinal surgery, post-splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long-term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor-associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. Conclusion: Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and | 1101 SHARATHKUMAR eT Al.

Incidental pulmonary embolism in oncologic patients—a systematic review and meta-analysis

“…PE has a multifactorial etiology with many independent risk factors associated with venous thromboembolism (VTE), such as surgery, trauma, hospitalization, malignant neoplasm with or without chemotherapy, and the use of central venous catheters [ 26 , 27 ].…”

Venous Thromboembolism among Critically Ill Children: A Narrative Review

“…36 The incidence rate of asymptomatic CVC-related DVT has been estimated at 24.7 cases per 1,000 line-days ($16 times of that reported for symptomatic cases) and observed in 50% of cases after the diagnosis of symptomatic PE. [37][38][39][40] In a prospective analysis of critically ill adolescents receiving surveillance ultrasonography in the PICU setting, Faustino and colleagues noted the presence of DVT in 12.4% (center variability: 6.3-19.8%), all of which occurred in mechanically ventilated patients. 39 While the clinical significance of asymptomatic VTE has been debated, 40 it is important to highlight that asymptomatic CVC-related DVTs may contribute to morbidity in the form of acquired bloodstream infections, paradoxical strokes, and, if the clinical team elects to remove the catheter, the temporary loss of central access.…”

“…From a VTE risk-benefit perspective, the extended duration of catheterization for any device may offset a perceived or actual benefit from a smaller catheter-to-vein diameter ratio. For asymptomatic VTE, 94% are accounted for by CVC-related DVT, raising the question regarding a potential role for surveillance ultrasonography 38 among critically ill children.…”

Anticoagulation in Pediatric Patients

“…Whether asymptomatic VTE, found incidentally or by radiographic screening, requires anticoagulant treatment is a matter of ongoing debate. [13][14][15] In practice, this decision is usually individualized dependent on the location and Sicherheit und Wirksamkeit zeigten sich jener von Standardantikoagulantien vergleichbar, ohne die Notwendigkeit für Monitoring. Weitere Studien sind noch am Laufen, welche voraussichtlich zu pädiatrischen Zulassungen von DOAKs für primäre Thromboprophylaxe in verschiedenen Hochrisikosituationen führen werden.…”