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[Thromboprophylaxis in critically ill children in Spain and Portugal]
A Rodríguez Núñez1, M Fonte2, E V S Faustino3
1Servicio de Críticos y Urgencias Pediátricas, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
Insights
Thromboprophylaxis is underutilized in critically ill children despite DVT risk factors. Low molecular weight heparin is common, but mechanical methods are rare, highlighting a need for clear guidelines.
Area of Science:
- Pediatric Critical Care Medicine
- Venous Thromboembolism Prevention
- Pharmacological Interventions
Background:
- Critically ill children face risks of deep venous thrombosis (DVT), yet data on incidence and prophylaxis effectiveness are limited.
- Identifying risk factors and current thromboprophylaxis practices in pediatric intensive care units (PICUs) is crucial.
Purpose of the Study:
- To assess thromboprophylaxis use in critically ill children in Spain and Portugal.
- To compare these practices with international data from other developed countries.
Main Methods:
- Secondary analysis of the multinational PROTRACT study data.
- Inclusion of patients under 18 years old in 59 PICUs across 7 countries, excluding those on therapeutic anticoagulation.
- Comparison of patient demographics and thromboprophylaxis strategies between Iberian (Spain/Portugal) and international PICUs.
Main Results:
- Iberian PICUs had higher frequencies of DVT risk factors, including central venous catheters and sepsis.
- Pharmacological thromboprophylaxis rates were similar (15.3% vs. 12.0%), with low molecular weight heparin predominantly used in Iberian patients.
- Mechanical thromboprophylaxis was significantly underused in Iberian PICUs (6.8%) compared to international PICUs (23.8%).
Conclusions:
- Thromboprophylaxis is infrequently prescribed in critically ill children, even with identified DVT risk factors.
- Low molecular weight heparin is the most common pharmacological agent, while mechanical prophylaxis is rarely employed.
- A consensus on standardized guidelines for thromboprophylaxis in pediatric critical care is urgently needed.
Introduction:
Although critically ill children may be at risk from developing deep venous thrombosis (DVT), data on its incidence and effectiveness of thromboprophylaxis are lacking.
Objective:
To describe the use of thromboprophylaxis in critically ill children in Spain and Portugal, and to compare the results with international data.
Material And Methods:
Secondary analysis of the multinational study PROTRACT, carried out in 59 PICUs from 7 developed countries (4 from Portugal and 6 in Spain). Data were collected from patients less than 18 years old, who did not receive therapeutic thromboprophylaxis.
Results:
A total of 308 patients in Spanish and Portuguese (Iberian) PICUS were compared with 2176 admitted to international PICUs. Risk factors such as femoral vein (P=.01), jugular vein central catheter (P<.001), cancer (P=.03), and sepsis (P<.001), were more frequent in Iberian PICUs. The percentage of patients with pharmacological thromboprophylaxis was similar in both groups (15.3% vs. 12.0%). Low molecular weight heparin was used more frequently in Iberian patients (P<.001). In treated children, prior history of thrombosis (P=.02), femoral vein catheter (P<.001), cancer (P=.02) and cranial trauma or craniectomy (P=.006), were more frequent in Iberian PICUs. Mechanical thromboprophylaxis was used in only 6.8% of candidates in Iberian PICUs, compared with 23.8% in the international PICUs (P<.001).
Conclusions:
Despite the presence of risk factors for DVT in many patients, thromboprophylaxis is rarely prescribed, with low molecular weight heparin being the most used drug. Passive thromboprophylaxis use is anecdotal. There should be a consensus on guidelines of thromboprophylaxis in critically ill children.
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