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Semin Thromb Hemost 2021; 47(06): 623-630
DOI: 10.1055/s-0041-1725117
Review Article

Community-Onset Venous Thromboembolism in Children: Pediatric Emergency Medicine Perspectives

Melissa White   *
1   Division of General Pediatrics and Adolescent Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Marisol Betensky‡   *
2   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
3   Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
,
Simone L. Lawson
4   Departments of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Neil A. Goldenberg
2   Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
3   Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
5   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. The majority of pediatric VTE events are associated with the presence of at least one underlying prothrombotic risk. Timely recognition of these risk factors in the emergency department (ED) setting is paramount for a prompt diagnosis and treatment initiation. Compared with children with hospital-acquired VTE, children presenting to the ED with new onset VTE tend to be older (>11 years of age), have a lower incidence of co-morbidities, and present more frequently with a deep venous thrombosis of the lower extremity. Currently, there are no validated pediatric-specific VTE clinical pretest probability tools that reliably assist with the accurate and timely diagnosis of pediatric VTE. Compression ultrasound with Doppler is the most common imaging modality used for VTE diagnosis, and low molecular weight heparins are the most common anticoagulants initiated in children presenting with VTE in the ED. Special consideration should be given to patients who present to the ED already on anticoagulation therapy who may require acute management for clinically-significant bleeding or change in antithrombotic therapy approach for progression/recurrence of VTE.

Keywords

thromboembolism - emergency department - pediatric

* These authors contributed equally to this work.




Publication History

Article published online:
10 May 2021

© 2021. Thieme. All rights reserved.

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