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Venous thromboembolism (VTE) is being diagnosed with increasing frequency in children. Unlike in adults, the majority of VTE in children is secondary. Central venous catheters (CVCs) are the most common cause of VTE in children (1). CVCs account for 90% of systemic VTE in neonates and renal vein thrombosis accounts for most of the non-CVC-related systemic VTE in the neonatal population (2). In older children, CVCs account for 60% of VTE, while malignancy and congenital heart diseases are the two most prominent disease categories associated with thrombosis (3). Approximately 0.7/100,000 children develop VTE (4). Given a conservative estimate that 1% of children with leukemia develop VTE, leukemia in children would therefore increase the risk of developing thrombosis by 1,400-fold. Most other underlying medical illnesses that predispose children to thrombosis are protein-losing conditions, such as nephrotic syndrome and inflammatory bowel disease (3, 5–7). Accurately defining these risk factors will enable targeting of specific pediatric populations for thromboprophylaxis. If one could prevent CVC-related thrombosis, most VTE in children would be prevented. In this chapter, we will review the evidence regarding whether to recommend thromboprophylaxis routinely in children with CVC and cancer. As neonatal renal vein thrombosis is the commonest VTE in neonates not caused by CVCs, we will also review the evidence for treatment of neonatal renal vein thrombosis.

This chapter will provide an “evidence-based” approach to “best management” of pediatric patients with venous thromboembolism. We acknowledge that …