Deep Vein Thrombosis In Children Research Articles

Risk factors of deep vein thrombosis in children with osteomyelitis

Objective To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT. Study design The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed. Results Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant Staphylococcus aureus (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT. Conclusions Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.

Catheter-associated deep vein thrombosis in children with severe traumatic brain injury: A single-center experience.

This study was performed to describe the single-center experience of deep vein thrombosis (DVT) in children with severe traumatic brain injury (sTBI) who were mechanically ventilated with a central line, and to identify potentially modifiable risk factors. It was hypothesized that children with DVT would have a longer duration of central venous line (CVL) and a higher use of hypertonic saline (HTS) compared to those without DVT. This was a retrospective study of children (0-18years) with sTBI, who were intubated, had a CVL, and a minimum intensive care unit (ICU) stay of 3days. Children were analyzed by the presence or absence of DVT. HTS use was evaluated using milliliter per kilogram (ml/kg) of 3% equivalents. Univariable and multivariable logistic regression models were used to determine which factors were associated with DVT. Seventy-seven children met inclusion criteria, 23 (29.9%) had a DVT detected in an extremity. On univariable analysis, children with DVT identified in an extremity had prolonged CVL use (14 vs. 8.5days, p=.021) and longer duration of mechanical ventilation (15 vs. 10days, p=.013). HTS 3% equivalent ml/kg was not different between groups. On multivariable analysis, mechanical ventilation duration was associated with DVT detection in an extremity, whereas neither CVL duration nor HTS use had an association. There was a high incidence of extremity DVT detected in children with sTBI who received invasive mechanical ventilation and had a CVL. HTS administration was not associated with DVT detection in an extremity.

Diagnostic value of D-dimers for limb deep vein thrombosis in children: A prospective study.

The present study sought to evaluate the discriminative and predictive ability of D-dimer for pediatric limb DVT. Children aged 28 days-18 years requiring imaging to rule out limb DVT, as per the treating clinical team, were enrolled in the study. The outcome was ultrasound proven DVT. The D-dimer levels were obtained around the time of imaging. Receiver operating characteristic (ROC) curves and logistic regression models were used for data analyses. In total, 296 patients were enrolled between 2017-2020; 204 patients were diagnosed with DVT (DVT[+]). Median D-dimer levels were 2.3μg/ml FEU (25th-75th percentile 0.9-3.9) among DVT(+) and 1.9μg/ml FEU (25th-75th percentile 0.8-4.0) among DVT(-) patients (p= 0.60). The area under the ROC curve (AUC) was 0.52 (95% confidence interval [CI] 0.45-0.59). The odds ratio for D-dimer levels was 1.00 (95% CI 0.99-1.01), holding confounders constant. In a sub-group exploratory analysis including 23 patients with no underlying conditions or co-morbidities, the AUC curve was 0.90 (95% CI 0.76-1.00). In conclusion, in this prospective cohort study of consecutive children with suspected limb DVT, D-dimer levels had poor discriminative and predictive ability for DVT. However, D-dimer levels showed better discriminative and predictive ability for DVT in an exploratory sample of patients with no underlying conditions or co-morbidities at the time of diagnosis.

Deep Vein Thrombosis Extending to Inferior Vena Cava in a Child

Deep Vein Thrombosis (DVT) is uncommon in children. We describe a case of DVT in children, highlighting importance of early diagnosis of rare disease. Here we report a case of 10-year-old boy presented with persistent pain and swelling of the left thigh. Detailed investigations led to diagnosis of DVT.

Predicting Thrombosis Recurrence in Children: The Role of Thrombophilia Testing

Background: The role of inherited thrombophilia testing in predicting a recurrence of deep vein thrombosis (DVT) after an incident of the first DVT in children remains unclear Objectives: To investigate the association between inherited thrombophilia and DVT recurrence. Design/Method: We conducted a retrospective regional study of all consecutive ICD10 codes of venous thromboembolism (VTE) in children over 15 years (January 1, 2000, to December 31, 2015) in a regional catchment area of southern Sweden using an electronic diagnosis registry. Eligible subjects were children aged 1-18 years presenting with DVT diagnosed with imaging and having undergone complete inherited thrombophilia workup after the first DVT event. Of the 174 patients diagnosed with DVTs, 139 were eligible for inclusion. Data regarding subject demographics and medical history, location of DVT and imaging method, coagulation studies at primary investigation including at least plasma concentrations of protein C, protein S, antithrombin, resistance to activated protein C, and the genotypes FVG1691A and FIIG20210A. Also, plasma values for coagulation factors, VIII and XI, D-dimer, INR, and cardiolipin antibodies, were analyzed. Results: A total of 139 patients had inherited thrombophilia workup after the incident of the first DVT. Inherited thrombophilia was found in 30 % of patients, the prevalence of minor thrombophilia among these 139 patients was 23 % (n = 32), whereas major thrombophilia accounted for 7 % (n = 10) of abnormal results. Anticoagulants as treatment were administered in 92 % of the first DVT. The majority of the cohort treated with anticoagulation therapy for 12 weeks. Patients with minor inherited thrombophilia treated for at least 24 weeks, whereas the patients with major inherited thrombophilia were continued on anticoagulation therapy for the long term. The incidence rate of recurrent thromboembolic events was 6.5 % (n = 9) of patients after their incident of the first thrombotic event. Recurrent thrombosis in patients with spontaneous DVT and proven inherited thrombophilia found in only 1 %. Conclusion: Inherited thrombophilia was not predictive of recurrent DVT among our cohort patients. Our findings suggest that Inherited thrombophilia testing may not predict risk for the recurrence of DVT, although it may help for adjustment of the duration of the anticoagulation therapy. Figure Disclosures No relevant conflicts of interest to declare.

Catheter-Associated Deep Vein Thrombosis (CADVT) in a Pediatric ICU: A Retrospective Case-Control Study

Highlights Abstract Introduction: Catheter-associated deep vein thrombosis (CADVT) in children has been recognized as a significant hospital-acquired condition. This study was undertaken to retrospectively analyze the impact of CADVT on outcomes and to identify risk factors for the development of deep vein thrombosis in children with central venous catheters. Methods: This was a single-center retrospective case-control study of patients with central venous catheters in a pediatric intensive care unit (ICU) from January 2014 to December 2018. Forty-one patients with central venous catheters who developed CADVT were compared with 100 random controls. Central venous catheter type, along with patient and disease-specific characteristics, were compared between the two groups by univariate and multivariate regression. Outcome comparison was made after adjusting for confounding variables. Results: Median time from insertion to the development of CADVT was 4 days (interquartile range, 2–9). Forty percent (16/40) of patients had a blood urea nitrogen greater than 20 mg/dL, and 86.6% (13/15) had a C-reactive protein greater than 1 mg/dL within 48 hours of development of CADVT. Central venous catheter duration (odds ratio [OR], 1.05), mechanical ventilation (OR, 7.49), and upper versus lower extremity site of the central venous catheter (OR, 0.324) were associated with the development of CADVT. Ultrasound guidance occurred significantly less in patients who developed CADVT (39.3% vs 70.7%); however, it was not independently associated with increased risk. Age, body mass index, mechanical ventilation, and severity of illness–adjusted hospital and ICU length of stay were significantly higher in patients who developed CADVT. Conclusions: CADVT is independently associated with worse outcomes. Ultrasound guidance and site selection are potential modifiable risk factors in the development of CADVT in pediatric patients. Future studies should target an effective chemoprophylaxis regimen.

Рецидивирующее течение тромбозов глубоких вен у детей с заболеваниями крови. Результаты моноцентрового исследования

Введение. Тромбозы глубоких вен (ТГВ) являются нередким осложнением течения и лечения у детей с заболеваниями крови и требуют проведения антитромботической терапии и профилактики для снижения количества повторных тромботических эпизодов. Цель исследования: анализ частоты и определение факторов риска повторных ТГВ у детей, госпитализированных для лечения заболеваний крови. Материалы и методы. Проведен ретроспективный анализ электронной базы данных пациентов в возрасте от 0 до 17 лет включительно, которым проводили стационарное лечение гемобластозов и синдромов костномозговой недостаточности в период 01.0.2012 по 31.12.2017. В анализ вошли только те пациенты, у которых было зарегистрировано более 1 случая тромбоза. Результаты. Рецидивы тромбозов наблюдали у 13,3 детей с асимптоматическими (аТГВ) и у 5,4 с симптоматическими (сТГВ) ТГВ. Рецидивы аТГВ при остром лимфобластном лейкозе (ОЛЛ) выявлены у 14,5, при остром миелобластном лейкозе (ОМЛ) у 8,9, при лимфоме у 11,9. У детей с сТГВ рецидивы тромбоза выявлены при ОЛЛ у 8,2, при ОМЛ у 8,3, при лимфоме у 2,8 пациентов. Медиана возраста пациентов с единственным эпизодом сТГВ составила 10 лет, с рецидивом сТГВ 9 лет, при аТГВ 7 лет для пациентов с единственным эпизодом и 6 лет с рецидивом аТГВ. Некорректно проведенная терапия была зарегистрирована у 50 детей. Заключение. Рецидивирующее течение тромбоза у детей, госпитализированных для лечения заболеваний крови, уста новлено у 5,4 детей с сТГВ и у 13,3 детей с аТГВ, причем 1/3 часть сТГВ является потенциально жизнеугрожающей. Полученные данные подчеркивают необходимость проведения вторичной антитромботической профилактики у детей с ТГВ и ставят вопрос о необходимости и целесообразности проведения таковой у пациентов с аТГВ. Introduction. Deep vein thrombosis (DVT) remains a common complication of hematological diseases in children and requires antithrombotic therapy and prophylaxis of recurrent thrombotic events. Aim: to determine incidence and risk factors of recurrent DVT for hospitalized children with blood diseases. Materials and methods. Medical records of patients hospitalized with oncohematological diseases and bone marrow aplasia, aged from 0 to 17 years, were analyzed retrospectively. Only patients with more than one DVT were taken into this analysis. Results. Recurrent DVT was diagnosed in 13.27 children with asymptomatic DVT (aDVT) and in 5.41 with symptomatic DVT (sDVT). Recurrent DVT was found in 14.49 children with acute lymphoblastic leukemia (ALL), in 8.89 with acute myeloblastic leukaemia (AML), in 11.86 with lymphomas. Incidence of recurrent thrombosis in children with sDVT was 8.16 for ALL, 8.33 for AML, 2.78 for lymphomas. Age analysis of patients with the single episode and recurrent thrombosis showed that age median with single sDVT was 10 years, recurrent DVT 9 years, in case of single asymptomatic or incidental (aDVT) episode 7 years, recurrent DVT 6 years. Incorrect therapy was registered for 50 of children with recurrent sDVT. Conclusion. Recurrent DVT in hospitalized children with blood diseases occurred in 5.41 children with sDVT and in children 13.33 with aDVT 1/3 episodes of sDVT was lifethreatening. In conclusion, secondary prophylaxis is needed for children with DVT and future research should be done for prophylaxis in those with aDVT.

Recurrent deep vein thrombosis in children with malignant blood diseases: literature review

Venous thromboembolism is not a rare complication in children with cancer. Despite the advantages of the treatment of venous thromboembolism there is still a probability of venous thromboembolism recurrence. In adult patients with cancer venous thromboembolism recurrence an influence on the lower survival rate. In children with cancer venous thromboembolism recurrence is a rare complication, but it can significantly reduce the quality of life. Risk factors of venous thromboembolism recurrence in children with cancer are not properly investigated.

Features of etiology and pathogenesis of acute deep vein thrombosis in children of different age groups. Results of a prospective cohort study in parallel groups

Aim. To study the characteristics of the etiology and clinical picture of acute deep vein thrombosis in children of different age groups. 
 Methods. The article analyzes the diagnosis and treatment of 77 children and adolescents with acute deep vein thrombosis. The features of the history of patients, previous fact of deep venous catheterization were studied. The fact of the presence and absence of clinical symptoms of thrombosis is registered. The results of ultrasound diagnostics are used. All patients underwent a course of anticoagulant therapy. The results of diagnosis and treatment were evaluated taking into account the age of the patients, the presence/absence of the history of catheterization of deep veins. 
 Results. When comparing different age groups, their distinctive characteristics were revealed: predominant presence of asymptomatic catheter-associated thrombosis in the younger age group (newborns and infants) with symptomatic deep vein thrombosis of various origin in older children. Among the surveyed, the majority (75.3%) had asymptomatic thrombosis. Pain (2.6%), edema (3.9%) and a combination of pain and edema (18.2%) were more common among symptomatic patients with the symptoms of acute vein thrombosis. In some cases, a combination of two or more complaints was noted. Asymptomatic thrombosis in the catheter-associated thrombosis group amounted to 96.6%. All patients below 1 year had a predisposing factor in the history: 95% - preceding vein catheterization, 5% - postoperative period. With a history of venous catheterization, symptoms of thrombosis were detected 9.2 times less frequently than in children without vein catheterization. In the group of children older than a year, the ratio of thrombosis without a predisposing factor was 10.5%, and the ratio of children with symptoms of thrombosis was 1.38 times higher than among children younger than a year. The only fatal outcome: a 17-year-old patient with a history of thrombophilia, thrombosis of the left iliac vein, pulmonary embolism. 
 Conclusion. Deep vein thrombosis in children of the first year of life in all cases was caused by a predisposing factor: in children during the first year of life in 95% of cases deep vein thrombosis was asymptomatic and was revealed by ultrasound examination.

Can thrombophilia predict recurrent catheter-related deep vein thrombosis in children?

AbstractThe role of thrombophilia testing in predicting catheter-related deep vein thrombosis (DVT) after an incident (ie, first) catheter-related DVT in children remains unclear. The present study investigated the association between thrombophilia and recurrent catheter-related DVT. Children with thrombophilia testing, performed according to the clinician's judgment and the family's preference, and a history of objectively confirmed catheter-related DVT were included in the study. Recurrent catheter-related DVT after placement of a new catheter was the main outcome. Thrombophilia was classified as minor, major, or none. Analysis was conducted using mixed effect logistic regression. A total of 245 patients had 1,365 catheters inserted; 941 of these catheters were placed after the incident catheter-related DVT. Anticoagulants as treatment or prophylaxis were administered in 78.1% of inserted catheters for at least 50% of the time they were in place. Minor thrombophilia was found in 12.7% of patients, whereas major thrombophilia was seen in 8.2% of children. The incidence rate of recurrent events was 0.23/100 catheter-days (95% confidence interval, 0.19-0.28 catheter-days); 34.3% (95% confidence interval, 28.6%-40.0%) of patients requiring a new catheter after their incident thrombotic event had at least 1 recurrent event. The incidence proportion of bleeding complications was 4.6/100 patients receiving anticoagulation. Young age of the patient at the time of catheter insertion and lack of administration of treatment or prophylactic doses of anticoagulant were predictive of recurrent events. In contrast, thrombophilia was not predictive of recurrent catheter-related DVT during subsequent catheter insertions among tested patients. Our findings suggest that thrombophilia testing to predict recurrence in these patients may be unnecessary.

Postthrombotic syndrome and other outcomes of lower extremity deep vein thrombosis in children

AbstractPediatric lower extremity deep vein thrombosis (LE-DVT) can lead to postthrombotic syndrome (PTS) and other adverse events. We investigated the outcomes of LE-DVT in children. Three groups were compared: non–line-related (Non-LR) DVT, LR DVT in neonates (LRneonates), and LR DVT in non-neonates (LRnon-neonates). A total of 339 children were included (Non-LR, n = 56; LRneonates, n = 95; and LRnon-neonates, n = 188). We found a statistically significant difference in the frequency of PTS (P = .04; 62.5%, 40.0%, and 46.3% in Non-LR, LRneonates, and LRnon-neonates, respectively), of recurrent LE-DVT (P = .001; 10.7% and 2.0% in Non-LR and LRnon-neonates, respectively), and pulmonary embolism (PE) (P < .001; 19.6% and 3.2% in Non-LR and LRnon-neonates, respectively) among groups. There was no difference in DVT resolution (P = .41). Multivariable analysis showed that DVT resolution, triggering event, and sex predicted Modified Villalta Scale (MVS; for pediatric PTS) scores >1; there was an interaction between DVT triggering event and sex. The time to reach an MVS >1 was significantly different when comparing groups (log-rank test, P < .001). Moreover, we found a significant difference in baseline MVS scores among groups, but the difference did not appear to change over time. In conclusion, LR LE-DVT had more benign outcomes than Non-LR DVT. Sex, DVT triggering event, and DVT resolution predicted LE-PTS in our cohort.

Clinical characteristics and risk factors of symptomatic central venous catheter-related deep vein thrombosis in children

Objective To investigate the clinical features and risk factors in children with symptomatic central venous catheter-related deep vein thrombosis, and to provide guidence for clinical therapy. Methods The clinical data of 105 children with central venous catheter were retrospectively analyzed.According to the thrombosis or not, these children were classified into two groups: thrombosis group and non-thrombosis group.The risk factors influencing symptomatic central venous catheter-related deep vein thrombosis forming were identified by Logistic regression analysis. Results Among the 105 cases with central venous catheter, the male to female ratio was 68∶37; age ranged from 8.5 months to 13 years old with average age(5.5±4.0)years old.There were 98 cases in non-thrombosis group and 7 cases in thrombosis group.Factors such as age[(5.7±4.1)years old vs.(2.5±1.8)years old], central venous catheter dwell time[(6.1±2.3)d vs.(8.9±2.1)d], more than 7 days parenteral nutrition application(11/98 cases vs.5/7 cases)and more than 7 days intravenous application of mannitol(7/98 cases vs.4/7 cases)were found significantly different between the thrombosis group and non-thrombosis group(P<0.05). Multivariate Logistic regression analysis showed that more than 7 days parenteral nutrition application and intravenous mannitol were the risk factors of symptomatic central venous catheter-related deep vein thrombosis[OR=50.703(95%CI 3.258-789.056), OR=15.590(95%CI 1.196-203.146), P<0.05]. Conclusion Symptomatic central venous catheter-related deep vein thrombosis is a common complication of deep venous catheterization.It cause acute pulmonary embolism and some critical diseases, and influence the prognosis and prolong hospital stay.Application of intravenous nutrition more than 7 days and intravenous mannitol more than 7 days are the risk factors of symptomatic central venous catheter-related deep vein thrombosis. Key words: Central venous catheter; Deep vein thrombosis; Children

Prevalence and risk factors for post thrombotic syndrome after deep vein thrombosis in children: A cohort study

BackgroundWhile post thrombotic syndrome (PTS) is increasingly recognized as a frequent and potentially serious complication of deep vein thrombosis (DVT) in children, limited information is available regarding predictors of PTS. MethodsUsing the Mayo Clinic Master Diagnostic Index, all pediatric patients (age 0 to 18years) with a potential DVT based on ICD-8 codes over the 15-year period, 1995 to 2009 were identified. A validated PTS survey instrument was mailed to eligible patients followed by a second mailing and three reminder phone calls for non-responders. Baseline clinical and radiographic characteristics were abstracted from patient medical records and tested as potential predictors of PTS using logistic regression. Associations were summarized by calculating odds ratios (OR) and corresponding 95% confidence intervals. ResultsNinety patients agreed to participate. The mean age (±SD) at DVT diagnosis and survey completion were 12.8 (±6.1) and 19.3 (±7.7) years, respectively. Fifty three respondents (59%) reported mild PTS whereas 12 (13%) reported moderate-to-severe PTS. Pain (34%) and dilated blood vessels (40%) were the most frequent PTS symptom and sign, respectively. On multivariate analysis, predictors of PTS included duration between incident DVT and survey completion (OR 1.75; 95% CI: 1.08 – 2.84) and number of thrombosed vein segments (OR 1.40; 95% CI: 1.05 – 1.86). ConclusionOver 70% of children with DVT report subsequent symptoms or signs of PTS, though only 13% report clinically significant, moderate-to-severe PTS. Number of thrombosed vein segments at diagnosis and time duration between incident DVT and survey completion were independent predictors of PTS.

Postthrombotic syndrome following upper extremity deep vein thrombosis in children

AbstractDespite its relatively estimated high occurrence, the characterization of pediatric upper extremity deep vein thrombosis (UE-DVT) and of UE postthrombotic syndrome (PTS) is still lacking. We investigated the occurrence, characteristics, and predictors of UE-PTS in a cohort of children with objectively confirmed UE-DVT. Patients were analyzed in 3 groups according to DVT pathogenesis and neonatal status: primary (G1), secondary neonates (G2neonates), and non-neonates (G2non-neonates). A total of 158 children (23 G1, 25 G2neonates, and 110 G2non-neonates) were included. The most common triggering factors were effort-related (87%) in G1 and central lines in G2neonates (100%) and in G2non-neonates (92%). PTS scores ≥1, as per the Modified Villalta Scale, were identified in 87% of primary patients, 16% of G2neonates, and 49% of G2non-neonates. Survival analysis showed that the time to PTS score ≥1 significantly differed among group (log-rank test P < .0001). A multivariable logistic regression showed that DVT pathogenesis and imaging-determined degree of thrombus resolution at the end of therapy were independent predictors of a PTS score ≥2. In conclusion, pediatric UE-PTS frequency and severity depend on UE-DVT pathogenesis (primary/secondary) and, within the secondary group, on patient's age. Line-related UE-PTS has a more benign course, particularly in neonates.

Natural history of deep vein thrombosis in children.

To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins. Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded. There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1-16 years. The median follow-up was 23 months, range 8-62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis (p = 0.012) and failure to recanalize (p = 0.036) increased significantly the risk for developing signs and symptoms. Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.

Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs)

The recent proliferation of deep vein thrombosis in children has been attributed to the increased use of central venous catheters, specifically tunneled lines and peripherally inserted central catheters. A formal comparison of the incidence rate for deep vein thrombosis between tunneled lines and peripherally inserted central catheters has not been undertaken. Children < 18 years of age who were admitted to Children's Hospital Los Angeles from July, 2005 to July, 2012 were eligible for inclusion. Data were extracted from the hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision coding. Patients were excluded if they received more than one central line. Data collected included type of central line, deep vein thrombosis event, and underlying medical illnesses classified according to chronic complex conditions. Over the seven year study period there was an overall rate of 73 deep vein thromboses per 10,000 hospital discharges. Of the 6915 eligible subjects, 181 had a deep vein thrombosis for an overall incidence rate of 2.6%. There were 152 thrombi (2.6%) in subjects with peripherally inserted central catheters and 29 thrombi (3.1%) in subjects with tunneled lines [OR=.83 (0.55, 1.29), p=0.38]. Despite the relative ease and simplicity of use of peripherally inserted central catheters leading to a substantial rise in their use, this study demonstrates that such lines pose a substantial risk for venous thrombosis and no difference in incidence was detected between such lines and tunneled lines.

Deep Vein Thrombosis in Children

We describe a rare case of deep vein thrombosis (DVT) in children, highlight the importance of early diagnosis of rare disease with potential complications. In a 5 year old boy presented with persistent leg pain without any obvious cause. Detailed investigation led to diagnosis of DVT. As there are common differential diagnoses for leg pain in children, pediatricians usually have a low index of suspicious of DVT in children. This case highlight that paediatricians must consider DVT in their differential diagnosis when children present with leg pain.

Deep vein thrombosis in children

Deep vein thrombosis in children

Management of peripherally inserted central catheter associated deep vein thrombosis in children

No protocol exists for prophylaxis or therapeutic management of peripherally inserted central catheter (PICC) related deep venous thrombosis (DVT) in children. Currently, very few patients are provided prophylaxis for DVT. In this study, we analyzed our current practice of PICC placement to identify the frequency of DVT, analyze risk factors and determine current treatment patterns in order to determine the need for protocols. The dataset was retrospectively collected from January 1, 2000 to December 31, 2011. Patients with an upper extremity PICC were assessed for subsequent DVT formation. Variables included: demographics, co-morbidities, method of DVT diagnosis, treatment course, and recurrence. There were 1,289 PICC placements, with 24 (1.9 %) per line events of DVT in 23 patients, of which 3 had recent surgery, 2 had sepsis, 1 had a family history of clots, and 2 had a malignancy. All but one was symptomatic. Diagnosis was made in 92 % by ultrasound, the remaining with CT. No patients had prophylaxis. Of the seven patients who underwent hypercoagulable work-up, three were positive. 15 patients were treated with enoxaparin, 5 patients were treated with heparin, 2 treated with tissue plasminogen activator and 2 were observed. 84 % were treated with long-term enoxaparin for a mean of 3.3 months with 54 % proven clot resolution and 1 patient had recurrence of UE DVT. The risk of DVT with PICC placement is small in children and prophylaxis can probably be reserved for those with previous DVT or known hypercoagulable state.

Natural History of Deep Vein Thrombosis in Children.

Natural History of Deep Vein Thrombosis in Children.