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International Angiology 2004 September;23(3):195-205

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Risk factors for venous thromboembolism in children

Gerotziafas G. T.

Unit of Biologic Hematology, Robert Debré Hospital, Paris, France

The inci­dence of ­venous throm­boem­bo­lism (VTE) is increas­ing in chil­dren as a ­result of ther­a­peu­tic advanc­es and ­improved clin­i­cal out­come in pri­mary ill­ness­es that pre­vi­ous­ly ­caused mor­tal­ity. VTE is most­ly diag­nosed in hos­pi­tal­ized chil­dren, espe­cial­ly sick new­borns with cen­tral ­venous cath­e­ters and older chil­dren with a com­bi­na­tion of risk fac­tors. ­Infants older than 3 ­months and teen­ag­ers are the larg­est ­groups devel­op­ing VTE. The most impor­tant trig­ger­ing risk fac­tors are the pres­ence of cen­tral ­venous lines, can­cer and chem­o­ther­a­py. Path­o­log­i­cal con­di­tions such as ­severe infec­tion, sick­le cell dis­ease, trau­ma and anti­phos­pho­lip­id syn­drome are asso­ciat­ed with the pres­ence of a hyper­coa­gu­lable state in chil­dren. The throm­bot­ic risk in oth­er­wise ­healthy chil­dren with a sin­gle iden­ti­fied throm­bo­phil­ic ­defect ­appears to be extreme­ly low. ­Venous throm­boem­bo­lism in pedi­at­ric ­patients is main­ly ­caused by com­bi­na­tions of at least 2 pro­throm­bot­ic risk fac­tors for ­venous throm­boem­bol­ic ­events in chil­dren are usu­al­ly asso­ciat­ed with under­ly­ing clin­i­cal con­di­tions and a trig­ger­ing risk fac­tor. In addi­tion, recur­rence of VTE after with­draw­al of anti­co­ag­u­lant treat­ment ­occurs in about 20% of ­patients after re-expo­sure to a trig­ger­ing risk fac­tor. A non neg­li­gible mor­tal­ity and mor­bid­ity is relat­ed to VTE in child­hood. This sup­ports the need for inter­na­tion­al mul­ti­cen­ter ran­dom­ized clin­i­cal ­trials to deter­mine opti­mal pro­phy­lac­tic and ther­a­peu­tic treat­ment for chil­dren with VTE. Risk fac­tor assess­ment for VTE in chil­dren has to be ­improved in order to opti­mize the pro­phy­lac­tic and ther­a­peu­tic strat­e­gies. The spe­cif­ic evo­lu­tion­ary char­ac­ter­is­tics of the hemo­sta­sis in chil­dren has to be taken into con­sid­er­a­tion when a pro­phy­lac­tic or ther­a­peu­tic strat­e­gy is ­applied.