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Prophylaxis of Venous Thromboembolism in Children: A Systematic Review

Lotte Hejberg Pedersen1, Gitte Bonde Villadsen1, Maja Hellfritzsch2

  • 1Faculty of Health, Aarhus University, Aarhus, Denmark.

Seminars in Thrombosis and Hemostasis
|June 30, 2022
PubMed

Insights

Pharmacological thromboprophylaxis for pediatric venous thromboembolism (VTE) is under-researched. Evidence suggests it benefits critically ill children with multiple risk factors, without increasing bleeding risk.

Area of Science:

  • Pediatric Hematology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Pediatric venous thromboembolism (VTE) is rare but serious.
  • Current VTE prophylaxis guidelines for children lack robust evidence, relying on adult data and expert opinion.

Purpose of the Study:

  • To systematically review evidence on the benefits of pharmacological thromboprophylaxis (low molecular weight heparin or unfractionated heparin) in children (≤18 years).
  • To identify specific pediatric populations that may benefit from thromboprophylaxis.

Main Methods:

  • Systematic review of studies published up to October 3, 2021, searching MEDLINE and Embase.
  • Included studies compared pharmacological thromboprophylaxis with no prophylaxis in children with radiologically verified VTE.
  • Data from 10 studies involving 976 children were analyzed across three population categories: intensive care unit (ICU), fracture/surgery, and systemic disease.

Main Results:

  • Reduced VTE incidence with thromboprophylaxis was observed in specific ICU populations (central venous catheter, mechanical ventilation; trauma with high risk) and children with acute lymphoblastic leukemia (ALL) on L-asparaginase/steroids with a central venous catheter.
  • No significant increase in bleeding risk was associated with pharmacological thromboprophylaxis.
  • VTE incidence was lower with prophylaxis in ICU patients with central venous catheter and mechanical ventilation (7/27 vs 13/24), ICU trauma patients (0/21 vs 13/96), and ALL patients (0/82 vs 8/121).

Conclusions:

  • Pharmacological thromboprophylaxis in children is sparsely investigated.
  • Evidence suggests thromboprophylaxis may benefit pediatric patients with multiple VTE risk factors, particularly in critical care settings.
  • Further research is needed to establish clear guidelines for pediatric VTE prophylaxis.

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