Thrombosis and thrombophilia in children: a systematic review.

Thrombotic events are uncommon disorders in childhood but increasingly recognized due to the progress made in the understanding of the hemostasis system and the importance of thromboembolic disorders in children. Multiple clinical underlying conditions and prothrombotic disorders contribute to the development of thrombosis in neonates and children. In recent years programs have emerged that specialize in the diagnosis, prevention, and treatment of thrombosis in children. This review summarizes the current knowledge of the risk factors for thromboembolic events in the venous and arterial systems in children, the use of antithrombotic prophylaxis, and the role of thrombophilia. First, the clinical manifestations and the problems of diagnosing venous thromboembolic diseases and cerebrovascular diseases in children are reviewed. The prophylactic use of anticoagulants in children is also discussed. Unfortunately there are no large prospective randomized trials in children, thus guidelines are based on small studies or on extrapolation of data from adults. Second, the impact of prothrombotic defects in pediatric patients and the issue of routine testing for these disturbances are reviewed.