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Thrombosis and Anticoagulation in Children

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Precision Anticoagulation Medicine

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Abstract

Venous thromboembolism (VTE) is being increasingly recognized in the pediatric population as a complication of health care. Estimates of the annual incidence of VTE in the general pediatric population range from 0.14 to 0.21/10,000 children. Risk factors include inherited causes as factor V Leiden mutation, prothrombin 20210, and protein C deficiency and acquired causes as central venous catheters, trauma, and immobilization.

The goals of treatment are to prevent extension and help resolution of the thrombus as well as prevent future recurrence. Anticoagulants used include low-molecular-weight heparin (LMWH), unfractionated heparin, and vitamin K antagonists as warfarin. LMWH has a higher predictable response and needs less frequent monitoring but requires parenteral administration. Warfarin has the least predictable response and is significantly affected by diet but has an advantage of easier oral administration. Thrombolytic agents (e.g., recombinant tissue plasminogen activator [tPA], urokinase) are used only in selected patients with major vessel occlusion, e.g., pulmonary embolism with hemodynamic compromise or compromise of organs or limbs. For patients with a known provoking factor as central venous catheterization, anticoagulation is recommended for 3 months with removal of the catheter. For unprovoked thrombus, longer duration of therapy up to 6 months is recommended.

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Abbreviations

aPL:

Antiphospholipid antibodies

aPTT:

Activated partial thromboplastin time

AT:

Antithrombin

CSVT:

Cerebral sinus venous thrombosis

CT:

Computerized tomography

CTPA:

Computed tomographic pulmonary angiography

CVADs:

Central venous access devices

CVCs:

Central venous catheters

DVT:

Deep vein thrombosis

FFP:

Fresh frozen plasma

HIT:

Heparin-induced thrombocytopenia

INR:

International normalized ratio

IT:

Inherited thrombophilia

LMWH:

Low-molecular-weight heparin

MRV:

Magnetic resonance venography

OCP:

Oral contraceptive pill

PCC:

Prothrombin complex concentrate

PE:

Pulmonary embolism

PICCs:

Peripherally inserted central catheters

PT:

Prothrombin time

PTS:

Postthrombotic syndrome

PVT:

Portal vein thrombosis

RVT:

Renal vein thrombosis

SLE:

Systemic lupus erythematosus

TPA:

Recombinant tissue plasminogen activator

TPN:

Total parenteral nutrition

UFH:

Unfractionated heparin

VKA:

Vitamin K antagonist

VTE:

Venous thromboembolism

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Author information

Authors and Affiliations

  1. Pediatrics and Pediatric Hematology, College of Medicine, Cairo University, Giza, Egypt

    Ahmed Maher Kaddah

  2. Pediatrics & Neonatology, College of Medicine, Cairo University, Giza, Egypt

    Iman Fathy Iskander

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  1. Ahmed Maher Kaddah
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  2. Iman Fathy Iskander
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Editors and Affiliations

  1. Saskatoon Cancer Centre College of Medicine University of Saskatchewan, Saskatoon, SK, Canada

    Hadi Goubran

  2. Faculty of Medicine Cairo University, Giza, Egypt

    Gaafar Ragab

  3. College of Human Medicine Michigan State University, East Lansing, MI, USA

    Suzy Hassouna

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Kaddah, A.M., Iskander, I.F. (2020). Thrombosis and Anticoagulation in Children. In: Goubran, H., Ragab, G., Hassouna, S. (eds) Precision Anticoagulation Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-25782-8_4

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  • DOI: https://doi.org/10.1007/978-3-030-25782-8_4

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