Thromboembolic Disorders in the PICU

Abstract

The burden of thromboembolic disease in hospitalized children appears to be increasing. This is likely a reflection of increased survival of children with complex medical problems with increased utilization of invasive procedures and central venous catheters. Infants and teenagers appear to be at the highest risk for thromboembolic disease due to age-associated changes in the hemostatic system. Venous thromboembolism in the PICU usually presents as deep vein thrombosis and requires a high index of suspicion for diagnosis; pulmonary embolism may occur as a consequence. Numerous inherited and acquired risk factors are associated with venous thrombosis in children, notably the use of central venous catheters and the presence of underlying diseases such as trauma, malignancy, congenital heart disease and congenital thrombophilic disorders. Radiologic studies are needed to make the diagnosis of venous thromboembolism, and evaluation for underlying thrombophilia should be considered. Anticoagulation is the mainstay of treatment for venous thrombosis and pulmonary embolism in children, while systemic or site-directed thrombolysis is reserved for life or limb threatening thrombosis. Management strategies and duration of anticoagulation therapy are extrapolated from adult data. While the role of thromboprophylaxis remains unclear in critically ill children, its use in high risk patients should be considered. Long term outcomes are not known, however recurrent thromboembolism and post thrombotic syndrome are known complications of venous thrombosis in children.