Pediatric Venous Thromboembolism Management
Summary
Pediatric venous thromboembolism (VTE) represents a growing concern in modern paediatric practice, driven by advances in intensive care, expanding use of intravascular devices and the advent of new pharmacological agents. Though still less common than in adults, VTE in children carries significant morbidity, including post-thrombotic syndrome and recurrent events, as well as substantial healthcare costs. Management encompasses careful risk assessment at hospital admission, stratification according to acquired and inherited factors, and application of tailored prophylactic strategies. Diagnosis relies primarily on non-invasive imaging, with ultrasound serving as the mainstay for deep vein thrombosis and computed tomography or magnetic resonance angiography for suspected pulmonary embolism. Treatment traditionally involves unfractionated heparin, low-molecular-weight heparin or vitamin K antagonists, all of which require laboratory monitoring and dose adjustments. Recent shifts towards direct oral anticoagulants have heightened interest in bodyweight-adjusted dosing regimens that promise fixed dosing, minimal monitoring and improved adherence. In select cases of life- or limb-threatening thrombosis, systemic or catheter-directed thrombolysis may be indicated, demanding specialised expertise. Multidisciplinary collaboration, standardised protocols and international registries are pivotal to optimise prevention, ensure prompt diagnosis and refine therapy in this vulnerable population.
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Pediatric Venous Thromboembolism Management publication trend
The graph below shows the total number of articles in pediatric venous thromboembolism management across all publications each year (not limited to Nature Index journals).
Technical terms
Venous thromboembolism (VTE): Obstruction of venous blood flow by a blood clot, encompassing deep vein thrombosis and pulmonary embolism.
Central venous catheter (CVC): A tube inserted into a large vein to administer medications or fluids, frequently implicated in thrombosis.
Anticoagulation: Therapeutic use of medications that prevent new clot formation or extension of existing clots.
Pharmacokinetics: Study of how a drug is absorbed, distributed, metabolised and eliminated by the body.
Direct oral anticoagulant (DOAC): A class of oral agents that specifically inhibit clotting factors without routine monitoring.
References
- Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism. Frontiers in Pediatrics (2017).
- Pediatric Hospital Acquired Venous Thromboembolism. Frontiers in Pediatrics (2017).
- The Impact of Central Venous Catheters on Pediatric Venous Thromboembolism. Frontiers in Pediatrics (2017).
- Pharmacokinetics of rivaroxaban in children using physiologically based and population pharmacokinetic modelling: an EINSTEIN-Jr phase I study. Thrombosis Journal (2018).
- Rivaroxaban for treatment of pediatric venous thromboembolism. An Einstein‐Jr phase 3 dose‐exposure‐response evaluation. Journal of Thrombosis and Haemostasis (2020).
- Pediatric Thrombolysis: A Practical Approach. Frontiers in Pediatrics (2017).
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