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Thromboembolic Disorders in the PICU

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Pediatric Critical Care Medicine

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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.

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Authors and Affiliations

  1. Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Ranjit S. Chima MD

  2. Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Dawn Pinchasik MD

  3. Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Cristina Tarango MD

Authors
  1. Ranjit S. Chima MD
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  2. Dawn Pinchasik MD
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  3. Cristina Tarango MD
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Corresponding author

Correspondence to Ranjit S. Chima MD .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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© 2014 Springer-Verlag London

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Chima, R.S., Pinchasik, D., Tarango, C. (2014). Thromboembolic Disorders in the PICU. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_23

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  • DOI: https://doi.org/10.1007/978-1-4471-6416-6_23

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6415-9

  • Online ISBN: 978-1-4471-6416-6

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