Challenging aspects of managing hemostasis in adolescents

The prevalence of symptomatic childhood venous thromboembolism increases among adolescents. The occurrence of nonhereditary prothrombotic risk factors, e.g. oral contraceptive pills, often prescribed to adolescent females for various indications, such as tobacco use, obesity and hypertension may trigger symptomatic thrombosis, especially in carriers of genetic thrombophilia traits. On the other hand, heavy menstrual bleeding is a common clinical problem of young adolescent women. A proper diagnostic workup of these women may enable physicians to detect and treat congenital bleeding disorders, e.g. von Willebrand disease, presenting with menorrhagia. The challenges of diagnosis and treatment of either thrombosis or bleeding disorders in young adults will be discussed in this review.