Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) events have increased over the last two decades. There is a need to better risk-stratify pediatric patients for HA-VTE in order to prevent acute and long-term complications.

Aims: We aim to better characterize pediatric HA-VTE events and outcomes at our institution using the International Society of Thrombosis and Hemostasis defined thrombotic risk factors, bleeding complications, and thrombosis outcomes in order to explore potential prophylactic VTE interventions.

Methods: This was a retrospective observational cohort study. All HA-VTE events occurring in children, 0 – 21 years old, admitted to our children’s hospital between 2011-2019 were analyzed. Patient demographics, central venous line (CVL) characteristics, VTE characteristics, and clinical outcomes were collected using the electronic medical record. Statistical analysis was descriptive with the use of logistic regression when comparing risk factors and thrombosis outcomes.

Results: In an eight year period, 68 HA-VTE unique patient events occurred, 98% associated with CVLs. Patient demographic and clinical data are outlined in Table 1. Site of VTE was distributed evenly between upper and lower extremity with 75% of VTE events located at the CVL site. Patients < 5 years old contributed 60% of the VTE events. Sixty-eight percent of patients achieved complete or partial resolution (CR/PR), while 32% did not. Only 82% of patients were anticoagulated. Thrombosis outcomes and complications are summarized in Figure 1. For patients achieving CR/PR, 19% developed complications versus 32% in those who did not achieve resolution (p= 0.12).

Conclusions: In our study, the majority of HA-VTE events occurred in younger, critically ill patients and related to a CVL. While the incidence of pediatric HA-VTE is rare, many patients experienced acute and long-term complications related to the thrombotic event or anticoagulation used. Improved prophylactic measures for those at greater risk for VTE is needed to prevent VTE events and their associated complications.

[Table 1. Patient Demographics]

[Figure 1. Pediatric Hospital-Acquired Venous Thromboembolism Outcomes]

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pediatric-hospital-acquired-venous-thromboembolism-mayo-eugenio-litta-childrens-hospital-experience/