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Are Children at Risk for Venous Thromboemboli?

February 14, 2022

When we think about patients who might be at risk for a venous thromboembolus, we usually immediately think about adults who are immobilized. However, it can happen to children as well!

This week, Pediatrics is early releasing an article entitled, “The Continued Rise of Venous Thromboembolism Across U.S. Children’s Hospitals,” by Dr. Sarah O’Brien and colleagues at Nationwide Children’s Hospital and Children’s Hospital of Philadelphia (10.1542/peds.2021-054649), which highlights  the rapid increase in the incidence of venous thromboemboli (VTE) in pediatric patients.

The authors analyzed data from the Pediatric Health Information System (PHIS) database. The results are stunning. Raffini et al had previously reported a 70% increase in the annual VTE rate from 2001 to 2007. Now, O’Brien et al report a 130% increase from 2008 to 2019! While there were increases in each age group, the most notable increases were seen in infants and adolescents.

Why the increase? Nobody knows, but it is speculated that it’s because we’re taking care of children with more complicated issues who would not have survived in the past and because there has been an increase in the use of central venous catheters. For the adolescents, there are the additional factors of increasing rates of obesity and immobility.

There is much more in this fascinating article, including factors that are associated with an individual’s increased chance of having a VTE. There is also a discussion about trends in prophylaxis and treatment of VTE in pediatric patients. However, there have been few clinical trials in this regard.

We clearly need to be thinking about the possibility of VTE in all of our hospitalized pediatric patients. And additional research on the best way to prevent these events is sorely needed.

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