Venous Thromboembolism Prophylaxis in High-Risk Pediatric Trauma Patients

Area of Science:

• Pediatric Trauma Care
• Venous Thromboembolism Prevention
• Pharmacology

Background:

• The safety and efficacy of chemical venous thromboembolism prophylaxis (cVTE) in pediatric trauma patients are not well-established.
• Recent recommendations proposed high-risk criteria for cVTE use, but prospective evaluation is lacking.

Purpose of the Study:

• To prospectively evaluate high-risk criteria and the use of cVTE in pediatric trauma patients.
• To assess the safety and efficacy of cVTE in preventing venous thromboembolism (VTE) in this population.

Main Methods:

• A prospective, multi-institutional cohort study involving 8 Level I pediatric trauma centers.
• Included pediatric trauma patients (<18 years) meeting defined high-risk criteria.
• Assessed receipt, timing of cVTE, VTE rates, and safety outcomes (bleeding complications).

Main Results:

• 460 high-risk pediatric trauma patients were studied; 54.5% received cVTE.
• VTE occurred in 1.6% of patients receiving cVTE within 24 hours, 6.9% receiving it after 24 hours, and 5.3% receiving no cVTE.
• Delayed cVTE initiation (after 24 hours) was significantly associated with increased VTE risk (OR 1.01).
• No bleeding complications were observed with cVTE use.

Conclusions:

• cVTE is safe in high-risk pediatric trauma patients, with no observed bleeding complications.
• Timely initiation of cVTE (within 24 hours) is crucial for effective VTE prevention.
• Quality improvement efforts should focus on optimizing prophylaxis timing and addressing implementation barriers.