1Department of Pediatrics, Yale School of Medicine, New Haven, CT. 2Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI. 3Department of Pediatrics, Washington University at St. Louis School of Medicine, St. Louis, MO. 4Department of Pediatrics, CHU Sainte-Justine University of Montreal, Montreal, QC, Canada. 5Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH. 6Pediatric Intensive Care Unit, University of Santiago de Compostela, Santiago de Compostela, Spain. 7Pediatric Intensive Care Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia. 8Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE. 9Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT. 10Department of Pediatrics, New York Medical College Maria Fareri Children's Hospital, Valhalla, NY. 11Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
Crit Care Med. 2014 May;42(5):1232-40. doi: 10.1097/CCM.0000000000000147.
Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated.
Prospective multinational cross-sectional study over four study dates in 2012.
Fifty-nine PICUs in Australia, Canada, New Zealand, Portugal, Singapore, Spain, and the United States.
All patients less than 18 years old in the PICU during the study dates and times were included in the study, unless the patients were 1) boarding in the unit waiting for a bed outside the PICU or 2) receiving therapeutic anticoagulation.
None.
Of 2,484 children in the study, 2,159 (86.9%) had greater than or equal to 1 risk factor for thrombosis. Only 308 children (12.4%) were receiving pharmacologic thromboprophylaxis (e.g., aspirin, low-molecular-weight heparin, or unfractionated heparin). Of 430 children indicated to receive pharmacologic thromboprophylaxis based on consensus recommendations, only 149 (34.7%) were receiving it. Mechanical thromboprophylaxis was used in 156 of 655 children (23.8%) 8 years old or older, the youngest age for that device. Using nonlinear mixed effects model, presence of cyanotic congenital heart disease (odds ratio, 7.35; p < 0.001) and spinal cord injury (odds ratio, 8.85; p = 0.008) strongly predicted the use of pharmacologic and mechanical thromboprophylaxis, respectively.
Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.
尽管危重症患儿发生深静脉血栓的风险增加，但很少有儿科研究确定血栓形成的发生率或血栓预防的疗效。我们检验了一个假设，即在危重症患儿中，即使存在血栓形成的适应证，也很少使用血栓预防。
2012 年四个研究日进行的前瞻性多国横断面研究。
澳大利亚、加拿大、新西兰、葡萄牙、新加坡、西班牙和美国的 59 个 PICU。
研究期间和时间段内 PICU 中年龄小于 18 岁的所有患者均纳入研究，除非患者 1）在该单元中转诊，等待 PICU 外的床位，或 2）正在接受治疗性抗凝治疗。
无。
在研究的 2484 名患儿中，2159 名（86.9%）存在 1 个或多个血栓形成危险因素。仅有 308 名患儿（12.4%）接受了药物性血栓预防治疗（例如阿司匹林、低分子量肝素或未分级肝素）。根据共识推荐，需要接受药物性血栓预防治疗的 430 名患儿中，仅有 149 名（34.7%）正在接受治疗。在 655 名年龄为 8 岁或以上的患儿中，有 156 名（23.8%）使用了机械性血栓预防，这是该设备的最小适用年龄。使用非线性混合效应模型，紫绀型先天性心脏病（比值比，7.35；p < 0.001）和脊髓损伤（比值比，8.85；p = 0.008）的存在强烈预测了药物性和机械性血栓预防的使用。
危重症患儿中很少使用血栓预防。即使对于存在血栓形成高风险且共识指南建议使用药物性血栓预防的患儿也是如此。
