Current practice perspectives on the management of thrombosis in children with renal insufficiency: The results of a survey of pediatric hematologists in North America

Abstract

No guidelines exist for the management of venous thromboembolic events (VTE) in children with renal insufficiency (RI). To define current practice patterns of VTE management in children with RI. An online multiple choice survey encompassing general questions/clinical scenarios related to thrombosis in RI. Pediatric hematologists who were members of Hemophilia and Thrombosis Research Society (HTRS) of North America. Response rate was 54% (39/75). VTE was perceived as the major hemostatic problem in children with RI by half (20/39) of respondents. All respondents used anticoagulation for treatment of VTE while 56% used it for prophylaxis of VTE in this population. Management practices varied with respect to choice of anticoagulants employed, consideration of prophylactic anticoagulation, and evaluation for hereditary thrombophilia. Low molecular weight heparin was perceived as a safe anticoagulation for VTE treatment by 77% of respondents given that anti-factor Xa monitoring was performed to assess bioaccumulation in RI. Thromboprophylaxis was considered for preventing thrombosis at central venous catheter, renal allo-graft and arterio-venous fistula in the context of previous history of thrombosis and congenital/acquired thrombophilia. The majority (>70%) would treat life-threatening emergencies such as superior vena cava syndrome with fibrinolytics despite RI. This pediatric study documents that substantial variability existed among pediatric hemologists with respect to VTE management in children with RI. Larger studies are required to better define the epidemiology and management of VTE in children with RI including the value of screening for underlying hereditary thrombophilia.