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Treatment of venous thromboembolism in pediatric patients

Char Witmer1, Leslie Raffini1

  • 1Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Blood
|January 10, 2020
PubMed

Insights

Pediatric venous thromboembolism (VTE) is a growing concern in children with medical conditions. New direct oral anticoagulants show promise for improving VTE treatment in this vulnerable population.

Area of Science:

  • Pediatric Hematology
  • Thrombosis Research
  • Clinical Pharmacology

Background:

  • Venous thromboembolism (VTE) is uncommon in healthy children but increasingly prevalent in those with underlying medical conditions.
  • Pediatric VTE cases are diverse, varying by age, thrombosis site, and comorbidities, complicating treatment strategies.
  • Current treatment relies heavily on adult data and expert consensus due to a lack of pediatric-specific clinical trials.

Purpose of the Study:

  • To review the current landscape of pediatric venous thromboembolism (VTE) management.
  • To highlight challenges unique to pediatric anticoagulation, including developmental hemostasis and central venous access devices.
  • To discuss emerging therapies and the role of collaborative research in advancing pediatric VTE care.

Main Methods:

  • Review of existing literature and clinical trial data on pediatric VTE.
  • Analysis of treatment challenges, including drug formulations and monitoring for neonates and infants.
  • Discussion of ongoing randomized clinical trials for direct oral anticoagulants in pediatric VTE.

Main Results:

  • Existing anticoagulants (low-molecular-weight heparin, warfarin) have limitations like injections and frequent monitoring.
  • Direct oral anticoagulants (DOACs) are under investigation, with trials expected to yield significant new evidence.
  • International registries are crucial for studying rare pediatric VTE subgroups and guiding disease-specific therapies.

Conclusions:

  • Pediatric VTE treatment is challenged by a lack of evidence and unique patient factors.
  • Ongoing trials of DOACs offer potential for improved pediatric VTE management.
  • Collaborative research and registries are essential for advancing personalized VTE therapy in children.

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