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Fighting the Hydra: Current Understanding ofPediatric Thrombosis

In 2009, Raffini et al. published a study utilizing

the Pediatric Hospital Inpatient System database

showing that from 2001 to 2007, the annual rate

of pediatric venous thromboembolism (VTE) in-

creased from 34 to 58 per 10,000 admissions.

The presence of a central venous line (CVL) is the

number one risk factor for the development of VTE

in the pediatric population. In addition, children with

a variety of medical conditions such as malignancy,

cardiac disease, autoimmune disease or nephrotic

syndrome are at increased risk for VTE. Of course,

it stands to reason that patients with more complex

diseases may also be those patients most likely to

have a CVL, but no specific studies have been

done to confirm that supposition. In addition, some

pediatric patients have an inherited risk of VTE

development. Research has demonstrated that

those patients with an inherited thrombophilia are

at increased risk of VTE, particularly in the pres-

ence of another acquired or inherited risk factor.

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In response to the increase in VTE, pediatric

hospitals have recently adopted thrombopro-

phylactic strategies. Little is known about the

appropriate strategies for VTE prevention in

neonates or other children at risk. In this issue

of Current Problems in Pediatric and Adolescent

Health Care, the authors seek to provide a guide

to the current state of pediatric VTE with respect

to inherited thrombophilias, acquired risk fac-

tors, and current recommendations for throm-

boprophylaxis in a pediatric hospital. It is

unlikely that one approach to prevention of

VTE will suffice, as it is clear that pediatric VTE

is not one disease, but rather a complication of

many different diseases. Each manifestation will

likely require a unique approach to achieve

success.

Shannon L. Carpenter, MD, MS

Curr Probl PediatrAdolesc Health Care, August 2013