Abstract:

Aim: To establish the incidence and characteristics of paediatric thrombosis (PT) in a Canadian tertiary care centre during the era of low molecular weight heparin (LMWH).

Methods: A retrospective observational case study of all patients <18 years of age evaluated for arterial and venous thrombosis from May 2008 to July 2018 at McMaster Children's Hospital was conducted through the electronic medical record.

Results: The incidence of PT was 52.2 per 10,000 hospital admissions (n=477/91462). Provoked thrombosis was more prevalent (88.9%, n=424/477) than unprovoked (2.9%, n=14/477) or idiopathic thrombosis (4%, n=19/477). Half of PT were in children <2 years (51.2%, n=244/477). Central vascular catheterisation was a contributory factor in more than half of thrombotic events (56.2%, n=268/477), while trauma (1.1%, n=5/477), oral contraceptives (4%, n=19/477), infection (4%, n=19/477), surgery (6.9%, n=33/477) and malignancy (8.4%, n=40/477) were also risk factors. Arterial ischemic stroke was diagnosed in 11.1% of cases (n=53/477), while pulmonary embolism was identified in 7.1% (n=34/477) and 1.7% of cases were fatal (n=8/477). LMWH was the first-line therapeutic of choice (47.8%, n=228/477), with 28.1% (n=134/477) requiring no intervention.

Conclusion: These data reiterate the elevated thrombosis risk to which infants and children with central vascular access are exposed.

Reference:

Biswas M, Ryan PM, Nakrani R, Bhatt M, Chan AKC, Mondal T. Central venous catheters are an important factor in paediatric thrombosis [published online ahead of print, 2020 Aug 20]. Acta Paediatr. 2020;10.1111/apa.15543. doi:10.1111/apa.15543