Thromboprophylaxis in the paediatric setting

Background

• No evidence for routine VTE risk assessment

• No evidence to support the routine use of thromboprophylaxis, mechanical or pharmacological

Incidence

• VTE rarely occurs in the paediatric population

• Incidence 0.7-1.0 per 100,000 population

• Peak incidence in neonates and adolescents

• Prevalence 5.3 per 10,000 hospital admissions.

Recommendations of best practice

• Early mobilisation

• Adequate hydration

• Prompt removal of central venous lines

• Consider site of insertion of CVL (Femoral vein is associated with highest incidence of thrombosis)

• Majority of VTEs are catheter related or have multiple underlying contributing factors such as

– Sepsis

– Immobility

– Malignancy

– Surgery

– Congenital heart disease

– Trauma

Contributing factors

Ca

When to seek advice

• If multiple contributing factors are present seek advice from paediatric consultant or paediatric haematologist to consider the risk benefit ratio of using thromboprophylaxis

BCSH guideline “Investigation, management, and prevention of VTE in children

Scenario 1

• 14 year old girl, newly diagnosed leukaemia, neutropenic sepsis, bed-bound, dehydrated

• What VTE prophylaxis does she require?

Scenario 1 Answer

• 14 year old girl, newly diagnosed leukaemia, neutropenic sepsis, bed-bound, dehydrated

• Follow recommendations of best practice, and seek specialist advice.

Scenario 2

• 14 year old boy with inflamed appendix, no other contributing factors for VTE

• What VTE prophylaxis does he require?

Scenario 2 Answer

• 14 year old boy with inflamed appendix, no other contributing factors for VTE

• Follow recommendations of best practice, no other prophylactic measures required.

Scenario 3

• 15 year old girl, newly diagnosed sarcoma compressing pelvic and iliac vessels, bed-bound, dehydrated

• What VTE prophylaxis does she require?

Scenario 3 Answer

• 15 year old girl, newly diagnosed sarcoma compressing pelvic and iliac vessels, bed-bound, dehydrated

• Follow recommendations of best practice, and seek specialist advice.

Certificate Thromboprophylaxis in the paediatric setting

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