Background: The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing in children, provoked by multiple risk factors such as central vascular catheters (CVCs), cancer, infection, and estrogen therapy. Like adults, pediatric patients with provoked DVT/PE are treated with anticoagulation for 3 months as long as risk factors are resolved. There is limited evidence regarding resolution rates in pediatric patients at the end of 3-month treatment.

Aims: To determine rates of complete resolution (CR), partial resolution (PR), and stable thrombosis (ST) in pediatric patients with provoked DVT/PE.

Methods: Retrospective chart review of pediatric patients with DVT/PE diagnosed in or admitted to McMaster Children’s Hospital between 2008 and 2020. Data extraction included demographics, thrombosis diagnosis, management, and follow-up imaging.

Results: 150 patients were diagnosed with 171 clots (Upper extremity DVT: 78, lower extremity DVT: 56, PE: 37). Median age was 13 years and male to female ratio was 0.83:1. Of the DVT patients, 85 had occlusive DVT and 49 had non-occlusive DVT. Common provoking factors were CVCs (55.3%), infection (29.3%), surgery (27.3%), and oral contraceptives (16%). The most frequently used anticoagulants were low-molecular-weight heparin (90%), direct oral anticoagulants (5.3%), and warfarin (3.3%). Two patients had surgical thrombectomy. Out of 110 patients that had a 3-month follow up, the rates of CR, PR, and ST were 56.4%, 30.9%, and 12.7%, respectively. Three patients (2%) had recurrent thrombosis.  

Conclusions: The rate of CR in pediatric patients with provoked DVT/PE is comparable to adults. Larger prospective studies are required to validate findings.  

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/resolution-rates-of-provoked-deep-vein-thrombosis-and-pulmonary-embolism-in-pediatric-patients-managed-at-a-tertiary-care-center/