Systemic thromboembolism in children

Summary

Thromboembolism (TE) has recently been recognized as a clinical entity in children. Determining the clinical characteristics of pediatric TE is an important first step in dealing with this new disorder. The paper summarizes 1776 consecutive children with systemic TE referred to 1-800-NO-CLOTS telephone consultation service. 1-800-NO-CLOTS is a free consultation service for clinicians managing pediatric TE. Patient information was collected immediately using standardized forms. In children with systemic TE, infants under one year of age (47%) including neonates (26%) represented the largest distinct pediatric age group. Age-related differences were seen in TE locations, associated conditions, and risk factors. However, venous TE was the most frequent manifestation (74%). Neonates and children with cardiac disorders were more likely to have an arterial TE than a venous TE Beyond the neonatal period, venous TE associated with a central line is more likely to occur than arterial TE. Children with ALL were 5.7 times more likely to have a venous TE than an arterial TE. TE were infrequent in otherwise healthy children with 90% of children having at least one risk factor. Central catheters were the single most common risk factor associated with TE, present in 2/3 of children. Ultrasound was most frequently employed for diagnosis of TE. Finally, there was marked heterogeneity in treatment of children with TE. In children, neonates form the largest single group with TE. TE usually occur only in the presence of one or more risk factors with catheters being the single most important factor.

Keywords

Children - thromboembolism - diagnosis - treatment - epidemiology

• References

• 1 Andrew M, David M, Adams M. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83: 1251-7.
• 2 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics 1995; 96: 939-43.
• 3 Kuhle S, Koloshuk B, Marzinotto V. et al. A cross-sectional study evaluating post thrombotic syndrome in children. Throm Res 2003; 11: 227-33.
• 4 Monagle P, Adams M, Mahoney M. et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res 2000; 47: 763-6.
• 5 Hausler M, Hubner D, Delhaas T. et al. Long term complications of inferior vena cava thrombosis. Arch Dis Child 2001; 85: 228-33.
• 6 Gurgey A, Aslan D. Outcome of noncatheterrelated thrombosis in children: influence of underlying or coexisting factors. J Pediatr Hematol Oncol 2001; 23: 159-64.
• 7 van Ommen CH, Ottenkamp J, Lam J. et al. The risk of postthrombotic syndrome in children with congenital heart disease. J Pediatr 2002; 141: 582-6.
• 8 Nowak-Gottl U, Von Kries R, Gobel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed 1997; 76: F163-F167.
• 9 van Ommen CH, Heijboer H, Buller HR. et al. Venous thromboembolism in childhood: A prospective two-year registry in The Netherlands. J Pediatr 2001; 139: 676-81.
• 10 Andrew M. Society for Pediatric Research Presidential Address: The 1-800-NO-CLOTS: A common vision. Pediatr Res 1998; 44: 964-73.
• 11 Heit JA, O’Fallon WM, Petterson TM. et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population based study. Arch Int Med 2002; 162: 1245-8.
• 12 Mitchell L, Andrew M, Hanna K. et al. A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase. Cancer 2003; 97: 508-16.
• 13 Prandoni P, Bernardi E. Upper extremity deep vein thrombosis. Curr Opin Pulm Med 1999; 05: 222-6.
• 14 Male C, Chait P, Ginsberg J. et al. Comparison of venography and ultrasound for the diagnosis of deep vein thrombosis in the upper body in children: A substudy of the PARKAA trial. Thromb Haemost 2002; 87: 593-98.
• 15 Roy M, Turner-Gomes S, Gill G. et al. Accuracy of doppler echocardiography for the diagnosis of thrombosis associated with umbilical venous catheters. J Pediatr 2002; 140: 131-4.
• 16 Andrew M, Vegh P, Johnston M. et al. Maturation of the hemostatic system during childhood. Blood 1992; 80: 1998-2005.
• 17 Mitchell L, Piovella F, Ofosu F. et al. Alpha-2-macroglobulin may provide protection from thromboembolic events in antithrombin IIIdeficient children. Blood 1991; 78: 2299-304.
• 18 Monagle P, Chan AK, Albisetti M. et al. The fibrinolytic system in adolescents: Response to venous occlusion stress tests. Pediatr Res 2003; 53: 333-7.
• 19 Revel-Vilk S, Chan AK, Bauman M. et al. Prothrombotic conditions in an unselected cohort of children with venous thromboembolic events. J Throm Haemost 2003; 01: 915-21.
• 20 Monagle P, Michelson AD, Bovill E. et al. Antithrombotic therapy in children. Chest 2001; 119: 344S-70S.
• 21 Streif W, Andrew M, Marzinotto V. et al. Analysis of warfarin therapy in pediatric patients: A prospective cohort study of 319 patients. Blood 1999; 94: 3007-14.