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Venous thromboembolic complications (VTE) in children: first analyses of
the Canadian Registry of VTE
M Andrew, M David, M Adams, K Ali, R Anderson, D Barnard, M Bernstein, L Brisson, B Cairney and D DeSai
Children's Hospital at Chedoke-McMaster, Hamilton, Ontario, Canada.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) occur in pediatric
patients; however, the incidence, associated morbidity, and mortality are
unknown. A Canadian registry of DVT and PE in children (ages 1 month to 18
years) was established July 1, 1990 in 15 tertiary- care pediatric centers.
One-hundred thirty-seven patients were identified prospectively and are the
subject of this report. The incidence of DVT/PE was 5.3/10,000 hospital
admissions or 0.07/10,000 children in Canada. Infants under 1 year old and
teenagers predominated with equal numbers of both sexes. DVT were located
in the upper (n = 50) and lower (n = 79) venous system, or as PE alone (n =
8). Central venous lines (CVLs) were present in approximately 33% of
children with DVT (n = 45). Associated conditions were present in 96% of
children and 90% of children had two or more associated conditions for DVT.
DVT was diagnosed by venography (n = 83), duplex ultrasound (n = 37), and
other combinations (n = 17). Twenty-two of the 31 ventilation/perfusion
scans performed were interpreted as high-probability scans for PE. Therapy
consisted of heparin (n = 115), thrombolysis (n = 15), surgical removal of
a CVL or thrombus (n = 22), and oral anticoagulant therapy (n = 103).
Significant bleeding complications did not occur. However, three (2.2%)
children died as a direct consequence of their thromboembolic disease; DVT
reoccurred in 23 children and postphlebitic syndrome (PPS) occurred in 26.
In conclusion, DVTs occur in a significant number of hospitalized children
with a mortality of 2.2%. Complications are not hemorrhagic, but
thrombotic, and characterized by PE, recurrent disease, and PPS. In
contrast to adults, the upper venous system is frequently affected because
of the use of CVLs. The frequency of DVT/PE justifies controlled trials of
primary prophylaxis in high-risk groups, and therapeutic trials to
determine optimal treatment.
Volume 83,
Issue 5,
pp. 1251-1257,
03/01/1994
Copyright © 1994 by The American Society of Hematology
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