Improving venous thromboembolism management in children undergoing surgery

O’Leary, James D.; Goobie, Susan M.

doi:10.1111/pan.13349

Cited by 2 publications

(1 citation statement)

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“…25 Each of these storage lesions, or all 3 in combination, are plausible mechanisms for increased thrombotic risk after transfusion of RBCs. 26 HA-VTE is a major public health concern and is recognized as a preventable 27 cause of morbidity and mortality. [28][29][30][31] Although less common in comparison with adults, HA-VTE is now recognized with increasing frequency in children.…”

Section: Figurementioning

confidence: 99%

Perioperative Transfusions and Venous Thromboembolism

et al. 2020

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BACKGROUND AND OBJECTIVES: Annual incidence of venous thromboembolism (VTE) including postoperative VTE in hospitalized children is rising significantly. A growing body of evidence supports the role of red blood cells (RBCs) in pathologic thrombosis. In this study, we examined the association of perioperative RBC transfusion with postoperative VTE in pediatric patients. METHODS:The pediatric databases of the American College of Surgeons' National Surgical Quality Improvement Project from 2012 to 2017 were used. Multivariable logistic regression was used to examine the association between perioperative RBC transfusion status and the development of new or progressive VTE within 30 days of surgery. The analyses were age stratified, as follows: neonates (#28 days), infants (.28 days and ,1 year), and children ($1 year).RESULTS: In this study, we included 20 492 neonates, 79 744 infants, and 382 862 children. Postoperative development of VTE was reported in 99 (0.48%) neonates, 147 (0.2%) infants, and 374 (0.1%) children. In all age groups, development of VTE was significantly more common among patients with a perioperative RBC transfusion than patients without a perioperative RBC transfusion (neonates: adjusted odds ratio [aOR] = 4.1, 95% confidence interval [CI] = 2.5-6.7; infants: aOR = 2.4, 95% CI = 1.7-3.6; children: aOR = 2.2, 95% CI = 1.7-2.9). Among children who received an intra-or postoperative transfusion, the weightbased volume of RBCs (mL/kg) transfused was associated with postoperative VTE in a dosedependent manner: second tertile (odds ratio = 2.3, 95% CI = 1.3-4.1) and third tertile (odds ratio = 4.1, 95% CI = 2.3-7.4) versus first tertile.CONCLUSIONS: Perioperative RBC transfusions are independently associated with development of new or progressive postoperative VTE in children, infants, and neonates. These findings need further validation in prospective studies and emphasize the need for evidence-based perioperative pediatric blood transfusion decisions.WHAT'S KNOWN ON THIS SUBJECT: Annual incidence of venous thromboembolism (VTE) including postoperative VTE in hospitalized children is rising significantly. A growing body of evidence supports the role of red blood cells in physiologic hemostasis as well as pathologic thrombosis.WHAT THIS STUDY ADDS: In this prospective registry study of .480 000 children, perioperative red blood cell transfusions were associated with higher odds of VTE within 30 days of a surgery in neonates, infants, and children, with a potential dose-response relationship among older children.

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