Abstract Number: PB0796
Meeting: ISTH 2021 Congress
Background: Pediatric‐specific data are lacking to guide recommendations for prevention and management of VTE in pediatric SCD. To date, experience and expert opinion in this area has not been reported.
Aims: We sought to characterize the experience and management practices of VTE in pediatric SCD via a multinational online survey of pediatric hematologists. We hypothesized there is substantial variability in preferences on the type and duration of anticoagulant therapy and thromboprophylaxis.
Methods: A QualtricsTM survey was emailed to pediatric hematologists members of the International Society on Thrombosis and Haemostasis, and the Hemostasis and Thrombosis Research Society (January-February 2021). Descriptive statistics were used to summarize results.
Results: The response rate was 42% (141 surveys emailed, 58 total responses, 52 complete responses analyzed). Table 1 shows the responders characteristics. Two-thirds (68%) of physicians treated at least one patient with SCD-associated VTE during the preceding 12 months. Ninety-eight percent reported to “always” use anticoagulation for symptomatic VTE, 78% for asymptomatic pulmonary embolism (PE) and 56% for asymptomatic deep venous thrombosis (DVT). Table 2 shows preferred agents for VTE treatment. Low-molecular-weight heparin was the preferred agent used for prevention of hospital-acquired VTE. Duration of therapy varied by VTE type, 95% of physicians prescribed 6 weeks-3 months for provoked DVT and 67% for provoked PE with the remaining 1/3 treating for 6-12 months. For unprovoked VTE, 62% treated for 6-12 months, while 25% prescribed a shorter 6 weeks-3 months course. The most challenging issue identified was determining the optimal duration and intensity of anticoagulation for secondary prophylaxis.
Responders Characteristics
| Table 2. Agent and Setting | Age Group 0 – <18 years 18 – 21 years | |
| Inpatient setting | ||
| Unfractionated Heparin no. (%) | 6 (12) | 6 (12) |
| Low Molecular Weight Heparin no. (%) | 50 (97) | 33 (64) |
| Warfarin no. (%) | 1 (2) | 1 (2) |
| Direct oral anticoagulant no. (%) | 2 (4) | 18 (35) |
| Outpatient setting | ||
| Low molecular weight heparin no. (%) | 48 (93) | 10 (20) |
| Warfarin no. (%) | 3 (6) | 1 (2) |
| Direct oral anticoagulant no. (%) | 9 (18) | 40 (77) |
Physicians Anticoagulant Agent of Preference for SCD-associated VTE by Age Group and Clinical Setting
Conclusions: This survey demonstrates variability in practice patterns in the management of SCD-related VTE, and identifies that optimal duration and intensity of secondary thromboprophylaxis is unclear. These findings highlight the need for cooperative multicenter studies to identify VTE prognostic factors and outcomes of pediatric SCD-related VTE, to inform future interventional studies.
To cite this abstract in AMA style:
Betensky M, Kumar R, Goldenberg NA. Results of a Multinational Survey of Diagnosis, Practices and Expertise in the Management of Venous Thromboembolism (VTE) in Pediatric Patients with Sickle Cell Disease (SCD) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/results-of-a-multinational-survey-of-diagnosis-practices-and-expertise-in-the-management-of-venous-thromboembolism-vte-in-pediatric-patients-with-sickle-cell-disease-scd/. Accessed May 19, 2022.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/results-of-a-multinational-survey-of-diagnosis-practices-and-expertise-in-the-management-of-venous-thromboembolism-vte-in-pediatric-patients-with-sickle-cell-disease-scd/