Guideline on the investigation, management and prevention of venous thrombosis in children*

Abstract

Summary Venous thrombo‐embolism (VTE) is increasingly recognized in paediatric practice. Few clinical trials have been performed in this area in children and management is largely extrapolated from adult practice where there is a considerable evidence base. This is likely to be unsatisfactory for a number of reasons. Firstly, there are significant differences in epidemiology and potential differences in the mechanisms for VTE in this age group. Secondly, many aspects of haemostasis are age‐dependant, which has implications for the use of anticoagulants in the paediatric population. Thirdly, there are very limited data available on the safety and efficacy of anticoagulants to manage specific indications in paediatric practice, often with limited paediatric formulations available. In addition, children may survive for a prolonged period following these events so that long‐term consequences may be highly significant in this age group. The aim of this guideline is to provide a rational basis for the investigation and management of children aged 1 month–16 years with VTE, including cerebral venous thrombosis (CVT). The guideline is targeted at healthcare professionals involved in the management of children and adolescents with VTE, particularly paediatric haematologists.

Risk of venous thromboembolism in children after general surgery

“…There are no population-based estimates of the risk of VTE following general surgery in childhood, which is considered to be a risk factor for VTE and is performed on over 40,000 children per year in England and 220,000 in the United States [6,13,14]. As a consequence of the lack of data on the risk of VTE following surgery there is currently a limited evidence base on which to make recommendations for prevention [1,15]. The current British guidelines on the prevention of VTE in children suggest that further work is required to define the risk of VTE in these patients to inform decisions on prophylaxis [1].…”

“…The rates of childhood VTE related hospitalisation have been reported to be increasing although this may reflect increased awareness, better diagnostic tools or increased use of indwelling catheters [5,7]. Known risk factors for VTE in childhood include central venous lines, sepsis, malignancy, surgery, trauma and medical comorbidities [1,[8][9][10][11][12][13]. There are no population-based estimates of the risk of VTE following general surgery in childhood, which is considered to be a risk factor for VTE and is performed on over 40,000 children per year in England and 220,000 in the United States [6,13,14].…”

“…As a consequence of the lack of data on the risk of VTE following surgery there is currently a limited evidence base on which to make recommendations for prevention [1,15]. The current British guidelines on the prevention of VTE in children suggest that further work is required to define the risk of VTE in these patients to inform decisions on prophylaxis [1]. We have therefore undertaken a large contemporary population-based study using linked healthcare data from both primary and secondary care in England to determine the risk of VTE following general surgery.…”

Five hematologic tests and treatments to question

“…[4][5][6][7][8][9] Randomized controlled trials have established that there is no significant benefit to prolonged anticoagulation in the setting of major, temporary VTE risk factors. 10 These recommendations are driven largely by a low risk of VTE recurrence after 3 months in the setting of a provoked VTE and are applicable to adult and pediatric patients, although the strength of the evidence is weaker for very young children.…”

Portal vein thrombosis in a patient with a malignant rhabdoid tumor of the liver (Case report)

“…«Золотым стандартом» в диагностике тромбозов сосудов бассейнов верхней и нижней полых вен явля-ется УЗИ венозного русла с цветным доплеровским картированием [17]. Также доказана высокая специ-…”