Venous Thromboembolism in Children: From Diagnosis to Management

Abstract

Venous thromboembolism (VTE) in children is a rare occurrence, although in recent decades we have seen an increase due to several factors, such as the rise in survival of subjects with chronic conditions, the use of catheters, and the increased sensitivity of diagnostic tools. Besides inherited thrombophilia, acquired conditions such as cardiovascular diseases, infections, chronic disorders, obesity and malignancy are also common risk factors for paediatric VTE. The treatment of paediatric VTE consists of the use of heparins and/or vitamin K antagonists to prevent dissemination, embolization, and secondary VTE. Randomized clinical trials of direct oral anticoagulants in paediatric VTE are ongoing, with the aim to improve the compliance and the care of patients. We reviewed the physiological and pathological mechanisms underlying paediatric thrombosis and updated the current diagnosis and treatment options.

Risk Assessment and Outcome of Venous Thromboembolism in Pediatric Population in an Academic Care Center of a Low-Middle Income Country

“…The management of pediatric VTE is principally derived from treatment guidelines for adult VTE 1 and the choice of LMWH in pediatric population is based on less laboratory monitoring and ease of administration as proven in a number of clinical studies. 2 , 20 , 24 Unfractionated heparin is mostly used for children with VTE who are at a high risk of bleeding or who require urgent procedural intervention as it is readily reversible and has other favorable properties. 25 New oral anticoagulants have been shown to be safe and efficacious anti-thrombotic agents in adults but their use in pediatric population is limited.…”

Successful Secondary Endovascular Intervention in Pediatric Patients with Venous Thromboembolic Events

“…2 Risk factors comprise hereditary deficiencies or mutations in coagulation factors, autoimmune diseases, malignant conditions, and anatomic risk factors, as well as transient risk factors like immobilization, infection, or intake of certain medications. 6 7…”

Catheter‐directed thrombolysis for massive deep vein thrombosis in an adolescent with severe antithrombin deficiency

“…Venous thromboembolic events (VTE) in children and adolescents are very rare with an incidence of roughly 0.7-2 per 100,000 children years compared with 100-150 per 100,000 patient years in adults. [1][2][3] The vast majority of VTE in children are related to acquired risk factors such as central venous catheters, which accounts for up to 90% of neonatal and 50% of pediatric VTEs. 1,4 Most of the remaining cases are related to cancer, infection and inherent risk factors such as severe hereditary thrombophilia and venous malformations while only very few idiopathic VTEs occur in the pediatric population 1,3,5,6 Inferior vena cava agenesis/hypoplasia is found in up to 5% of patients younger than 30 years presenting with lower limb deep vein thrombosis.…”

“…[1][2][3] The vast majority of VTE in children are related to acquired risk factors such as central venous catheters, which accounts for up to 90% of neonatal and 50% of pediatric VTEs. 1,4 Most of the remaining cases are related to cancer, infection and inherent risk factors such as severe hereditary thrombophilia and venous malformations while only very few idiopathic VTEs occur in the pediatric population 1,3,5,6 Inferior vena cava agenesis/hypoplasia is found in up to 5% of patients younger than 30 years presenting with lower limb deep vein thrombosis. 5,7 The prevalence in the general population is estimated to be between 1/100 and 1/200.000.…”