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Multiple Causes Responsible for Recent Rise in Pediatric Venous Thromboembolism

by Mark Shen, MD, SFHM, FAAP

Most would agree that "we are seeing more thrombosis over time" in children over the past decade, and although we don't know why, it is likely due to multifactorial causes, said Leslie Raffini, MD, MSCE, director of the Hemostasis and Thrombosis Center at Children's Hospital of Philadelphia, in a session on Monday at HM12.

Central venous catheters remain a significant risk factor for venous thromboembolism (VTE) and our knowledge of inherited risk factors has expanded in recent years. While it is likely that inherited risk factors increase the risk of thrombosis in children, the question of testing has engendered debate, due in large part to the lack of clear benefit of that information in the majority of situations.

"The decision to test should be made on an individual basis, after counseling," said Dr. Raffini. "Results should be interpreted by an experienced physician with adolescent females most likely to benefit from the testing. There are no recommendations for what to do with pediatric patients" despite the fact that this is an important cause of morbidity in high-risk patients.

Dr. Raffini describes efforts at Children's Hospital of Philadelphia that led to a VTE prophylaxis guideline. Successful implementation of the guideline required significant multidisciplinary collaboration, and an analysis of outcomes is underway.

Takeaways

• The decision to test for inherited risk factors should be individualized.
• Adolescent females are most likely to benefit from testing for inherited risk factors.
• Implementation of guidelines requires intentional multidisciplinary collaboration.