Pediatric Thrombosis

Venous thromboembolism is generally considered to be a rare event in the pediatric population. However, the incidence is increasing, particularly in tertiary care centers. The vast majority of thromboses in pediatric patients are provoked, occurring most commonly in children with chronic healthcare conditions, who are admitted to the hospital, or who have central venous catheters. Due to the rarity of VTE, the treating provider needs to have a high index of suspicion in pediatric patients with chronic healthcare conditions, with central venous catheters, or who are admitted to the hospital and present with typical VTE symptoms. As in adults, Doppler ultrasound is frequently the optimal diagnostic tool for extremity VTE. The D-dimer has not been established to be as useful in the pediatric population. Treatment of VTE in the neonatal population requires an understanding of the unique characteristics of the developing hemostatic system. However, in general, in neonatal patients as well as older children and teens, thromboses are treated with anticoagulation according to national guidelines. The typical duration of anticoagulation is 3 months, with longer duration depending on the underlying pathophysiology, contributing risk factors, and ongoing risk assessments. Anticoagulation can be difficult in neonates, children, and teens as their risk for bleeding varies significantly depending on activities.