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Acute Management and Bleeding Outcomes in Pediatric Pulmonary Embolism: A Large, Single-Center Retrospective Cohort

Kristina M Wagner1,1, Leslie Raffini1, Hilary Whitworth1,2

  • 1The Children's Hospital of Philadelphia, Pennsylvania, United States, Philadelphia.

Seminars in Thrombosis and Hemostasis
|June 25, 2026
PubMed

Insights

Pediatric pulmonary embolism (PE) management lacks evidence, especially for reperfusion therapies. This study found reperfusion generally safe in select pediatric patients, but high-risk PE cases show high bleeding and mortality rates.

Area of Science:

  • Pediatric Medicine
  • Cardiology
  • Hematology

Background:

  • Pediatric pulmonary embolism (PE) is a rare but serious condition with limited evidence guiding treatment, particularly reperfusion therapies.
  • Bleeding outcomes are crucial for risk-benefit assessments in pediatric PE management but are infrequently studied.

Purpose of the Study:

  • To describe risk factors, management, and acute outcomes, including bleeding and mortality, in pediatric patients (<21 years) receiving acute PE care.
  • To evaluate the safety and outcomes of reperfusion therapies in pediatric PE patients.
  • To characterize bleeding events in relation to PE severity and treatment modality.

Main Methods:

  • Retrospective cohort study of 175 pediatric patients (<21 years) with acute PE between 2003 and 2022, excluding those with comorbid cardiac disease.
  • Data collected on PE risk factors, in-hospital management (anticoagulation alone vs. reperfusion therapy), and acute outcomes (bleeding, mortality).
  • Patients categorized by PE risk: low-risk (69%), intermediate-risk (25%), and high-risk (6%).

Main Results:

  • Most patients (69%) had low-risk PE; 29 received reperfusion therapy, primarily systemic thrombolysis.
  • Clinically relevant bleeding occurred in 27 patients (15%), with major bleeding in 5%. Bleeding rates were similar between anticoagulation alone and systemic thrombolysis groups.
  • High-risk PE patients experienced high rates of clinically relevant bleeding (73%) and mortality (45%). Most major bleeding events had independent risk factors.

Conclusions:

  • Reperfusion therapy appears well-tolerated in select pediatric PE patients.
  • High-risk pediatric PE is associated with substantial bleeding and mortality risks.
  • Prospective studies with standardized bleeding outcome collection are needed to guide pediatric PE management decisions.

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