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American Academy of Pediatrics
Clinical Question Review

Venous Thromboembolism in Hospitalized Adolescents: An Approach to Risk Assessment and Prophylaxis

Katie A. Meier, Eloise Clark, Cristina Tarango, Ranjit S. Chima and Erin Shaughnessy
Hospital Pediatrics January 2015, 5 (1) 44-51; DOI: https://doi.org/10.1542/hpeds.2014-0044
Katie A. Meier
1Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Eloise Clark
2James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Cristina Tarango
3Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
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Ranjit S. Chima
4Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Erin Shaughnessy
1Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Abstract

Background: Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children’s hospital sought to answer the following clinical question: “Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?”

Methods: Serial literature searches using key terms were performed in the following databases: Medline, Cochrane Database, CINAHL (Cumulative Index to Nursing and Allied Health), Scopus, EBMR (Evidence Based Medicine Reviews). Pediatric studies were sought preferentially; when pediatric evidence was sparse, adult studies were included. Abstracts and titles were screened, and relevant full articles were reviewed. Studies were rated for quality using a standard rating system.

Results: Moderate evidence exists to support VTE risk assessment in adolescents. This evidence comes from pediatric studies that are primarily retrospective in design. The results of the studies are consistent and cite prominent factors such as immobilization and central venous access. There is insufficient evidence to support specific prophylactic strategies in pediatric patients because available pediatric evidence for thromboprophylaxis efficacy and safety is minimal. There is, however, high-quality, consistent evidence demonstrating efficacy and safety of thromboprophylaxis in adults.

Conclusions: On the basis of the best available evidence, we propose a strategy for risk assessment and stratified VTE prophylaxis for hospitalized adolescents. This strategy involves assessing risk factors and considering prophylactic measures based on level of risk. We believe this strategy may reduce risk of VTE and appropriately balances the adverse effect profile of mechanical and pharmacologic prophylactic methods.

  • pediatrics
  • prevention and control
  • pulmonary embolism
  • quality assurance
  • health care
  • risk assessment
  • venous thromboembolism
  • venous thrombosis
  • Abbreviations:
    CI
    confidence interval
    DVT
    deep vein thrombosis
    LEGEND
    Let Evidence Guide Every New Decision
    LMWH
    low molecular weight heparin
    RR
    relative risk
    SCD
    sequential compression device
    VTE
    venous thromboembolism
    • Copyright © 2015 by the American Academy of Pediatrics
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    Hospital Pediatrics: 5 (1)
    Hospital Pediatrics
    Vol. 5, Issue 1
    1 Jan 2015
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    Venous Thromboembolism in Hospitalized Adolescents: An Approach to Risk Assessment and Prophylaxis
    Katie A. Meier, Eloise Clark, Cristina Tarango, Ranjit S. Chima, Erin Shaughnessy
    Hospital Pediatrics Jan 2015, 5 (1) 44-51; DOI: 10.1542/hpeds.2014-0044

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    Venous Thromboembolism in Hospitalized Adolescents: An Approach to Risk Assessment and Prophylaxis
    Katie A. Meier, Eloise Clark, Cristina Tarango, Ranjit S. Chima, Erin Shaughnessy
    Hospital Pediatrics Jan 2015, 5 (1) 44-51; DOI: 10.1542/hpeds.2014-0044
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    • Getting Closer to Optimizing the Prevention and Detection of VTE in Hospitalized Children
    • Development of a Surveillance System for Pediatric Hospital-Acquired Venous Thromboembolism
    • Screening Guidelines for Venous Thromboembolism Risk in Hospitalized Children Have Low Sensitivity for Central Venous Catheter-Associated Thrombosis
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    Keywords

    • pediatrics
    • prevention and control
    • pulmonary embolism
    • quality assurance
    • health care
    • risk assessment
    • venous thromboembolism
    • venous thrombosis
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