Pediatric thrombosis

This chapter reviews thrombosis in pediatric patients–frequent sites of occurrence and complications. Then the dosing and use of antithrombotic therapy is discussed. Thrombosis is a rare event in the pediatric population, but the incidence has increased over the last decade and current estimates indicate an incidence of approximately 188 venous thromboembolic events per 100,000 discharges. Pediatric thrombosis occurs in a bimodal distribution, with a first peak in the neonatal period and a second peak in the adolescent years. However, when normalized for hospital admissions and discharges, the incidence of thrombosis increases with age. In general, pediatric thrombosis is a tertiary care problem with more events occurring in children with chronic care conditions such as congenital heart defects, renal disease, or malignancies as well as in children admitted to the ICU, who have experienced trauma or who have central venous catheters. Over 90 % of pediatric thromboses are provoked or associated with an underlying condition. Treatment of thrombosis in the pediatric population requires special consideration due to the unique characteristics of the developing hemostatic system, the likelihood that affected children will go on to live for decades after their thrombotic event, and the risk of anticoagulation in a young and active patient.