Thrombosis in Paediatrics: Genetic versus Environmental Risk Factors and Implications for Management

Abstract

Virchow, the famous German pathologist, described the three critical factors for the development of thrombosis as being disturbances in blood flow, abnormalities in the blood vessel wall, and disturbances in the blood constituents that led to hypercoagulability. Over 150 years later, this triad remains perhaps the most useful way to think about risk factors for thrombosis, and to consider the relative contributions of genetic versus environmental factors contributing to thrombosis. As will be demonstrated throughout this chapter, environmental risk factors seem far more important to the aetiology, presentation, and management of thrombosis in children than do genetic factors. One cannot conclude that genetic factors play no role; however, the available evidence supports that in a multi-hit causation model, the major causative factors for thrombosis in children are acquired clinical, pathological and iatrogenic factors. Thus, in managing thrombosis in children, it is the amelioration of these factors that are the most important. However, there remains much to be learnt about the interaction of the coagulation system in children and the pathogenesis of thrombosis.