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Updated: May 4, 2026
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Published on: November 26, 2013
A multinational study of thromboprophylaxis practice in critically ill children
Edward Vincent S Faustino1, Sheila Hanson, Philip C Spinella
11Department of Pediatrics, Yale School of Medicine, New Haven, CT. 2Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI. 3Department of Pediatrics, Washington University at St. Louis School of Medicine, St. Louis, MO. 4Department of Pediatrics, CHU Sainte-Justine University of Montreal, Montreal, QC, Canada. 5Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH. 6Pediatric Intensive Care Unit, University of Santiago de Compostela, Santiago de Compostela, Spain. 7Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia. 8Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE. 9Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT. 10Department of Pediatrics, New York Medical College Maria Fareri Children's Hospital, Valhalla, NY. 11Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
Critically ill children often have thrombosis risk factors but rarely receive thromboprophylaxis. This study found that even when recommended by guidelines, pharmacologic thromboprophylaxis is underutilized in pediatric intensive care units.
Area of Science:
- Pediatric critical care medicine
- Venous thromboembolism prevention
- Pharmacologic and mechanical thromboprophylaxis
Background:
- Critically ill children face elevated risks of deep venous thrombosis (DVT).
- Limited pediatric research exists on DVT prevalence and thromboprophylaxis effectiveness.
- This study addresses the hypothesis of infrequent thromboprophylaxis use in high-risk pediatric patients.
Purpose of the Study:
- To assess the prevalence of thromboprophylaxis use in critically ill children.
- To determine if thromboprophylaxis is administered according to established guidelines.
- To identify factors influencing thromboprophylaxis administration in pediatric intensive care units (PICUs).
Main Methods:
- A prospective, multinational, cross-sectional study conducted across 59 PICUs in 2012.
- Included patients under 18 years old not receiving therapeutic anticoagulation.
- Data collected over four study dates.
Main Results:
- Out of 2,484 children, 86.9% had at least one thrombosis risk factor.
- Only 12.4% received pharmacologic thromboprophylaxis.
- Of those indicated for pharmacologic thromboprophylaxis, only 34.7% received it.
- Mechanical thromboprophylaxis was used in 23.8% of eligible patients aged 8+.
- Cyanotic congenital heart disease and spinal cord injury predicted thromboprophylaxis use.
Conclusions:
- Thromboprophylaxis is significantly underused in critically ill children.
- Underutilization persists even in high-risk pediatric patients recommended for pharmacologic thromboprophylaxis.
- Current practices fall short of consensus guideline recommendations for DVT prevention in this population.
Objectives:
Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated.
Design:
Prospective multinational cross-sectional study over four study dates in 2012.
Setting:
Fifty-nine PICUs in Australia, Canada, New Zealand, Portugal, Singapore, Spain, and the United States.
Patients:
All patients less than 18 years old in the PICU during the study dates and times were included in the study, unless the patients were 1) boarding in the unit waiting for a bed outside the PICU or 2) receiving therapeutic anticoagulation.
Interventions:
None.
Measurements And Main Results:
Of 2,484 children in the study, 2,159 (86.9%) had greater than or equal to 1 risk factor for thrombosis. Only 308 children (12.4%) were receiving pharmacologic thromboprophylaxis (e.g., aspirin, low-molecular-weight heparin, or unfractionated heparin). Of 430 children indicated to receive pharmacologic thromboprophylaxis based on consensus recommendations, only 149 (34.7%) were receiving it. Mechanical thromboprophylaxis was used in 156 of 655 children (23.8%) 8 years old or older, the youngest age for that device. Using nonlinear mixed effects model, presence of cyanotic congenital heart disease (odds ratio, 7.35; p < 0.001) and spinal cord injury (odds ratio, 8.85; p = 0.008) strongly predicted the use of pharmacologic and mechanical thromboprophylaxis, respectively.
Conclusions:
Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.
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