In-hospital venous thromboembolism (VTE) represents a significant, yet preventable, public health burden, which was recognized in 2008 by the USA Surgeon General’s Call-to-Action . Prophylactic anticoagulation for VTE prevention has been proven to be safe and effective, and has become standard care in hospitalized adults [2,3]. As providers become increasingly aware of the growing problem of VTE in hospitalized children, attention is starting to focus on prevention in this population.
The available data regarding utility and safety of primary prophylaxis is sparse, likely due to the relative infrequency of VTE in children compared to their adult counterparts. Since high-quality evidence in this area is lacking, clinical care is often formulated by expert consensus and extrapolation from adult studies. Two important considerations are clinician awareness of in-hospital VTE, and risk-stratified approaches to prevent unnecessary exposure of low-risk patients to potentially serious side effects. While this is an area expected to evolve greatly, this chapter provides a contemporary review of pertinent background information, risk factors for in-hospital VTE development, and existing recommendations for pharmacologic and non-pharmacologic VTE prophylaxis in children.
Although the incidence of in-hospital VTE is considerably lower in children than adults, it is an increasing problem particularly in pediatric tertiary care hospitals, with potential for severe consequences . Possible explanations for the rising incidence include advances in tertiary care, prolonged survival of medically complex patients, increased utilization of central venous access devices (CVADs), improved imaging sensitivity, and increased awareness. Of children with VTE, 16% to 20% have objectively confirmed pulmonary embolism (PE) , and retrospective data from the Hospital for Sick Children indicates a VTE-specific mortality rate of 9% among pediatric PE cases . The risks of long-term pulmonary insufficiency and chronic thromboembolic pulmonary hypertension following PE in children remain undefined.