Lyle Courtney A, Sidonio Robert F, Goldenberg Neil A
aDepartment of Pediatrics, Billings Clinic, Billings, Montana bDepartment of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia cJHM Pediatric Thrombosis Program, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida dJohns Hopkins Children's Center and Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA *Coutney A. Lyle and Robert F. Sidonio contributed equally to the writing of this article.
Curr Opin Pediatr. 2015 Feb;27(1):18-25. doi: 10.1097/MOP.0000000000000173.
Pediatric venous thromboembolism (VTE) can affect children of all ages, requiring considerable pharmacologic intervention and is often associated with significant morbidity. Current research efforts are directed toward the development of risk-stratified VTE prevention strategies employing pharmacologic thromboprophylaxis, the optimization of conventional anticoagulation, and the investigation of the safety and efficacy of target-specific oral anticoagulants (TSOACs) in children.
Recent research has considerably improved the understanding of risk factors of hospital-acquired VTE and how these factors may be employed in risk-stratified paradigms for VTE prevention in children. Additional insight has been gained in the optimization of conventional anticoagulants in special populations such as neonates and children with inflammatory conditions, and in improving the overall safety and compliance with periprocedural anticoagulation and the use of home International Normalized Ratio monitoring. Furthermore, the use of TSOACs has been described in children and is the focus of numerous ongoing clinical trials that are evaluating the safety and efficacy of these agents in children with VTE.
Identification of hospital-acquired VTE risk factors may inform pediatric VTE prevention strategies. Although initial use of TSOACs may be promising, investigation of safety and efficacy in children is still underway.
儿童静脉血栓栓塞症（VTE）可影响各年龄段儿童，需要大量药物干预，且常伴有严重的发病率。目前的研究工作致力于开发采用药物性血栓预防的风险分层VTE预防策略、优化传统抗凝治疗以及研究新型口服抗凝剂（TSOACs）在儿童中的安全性和有效性。
最近的研究极大地增进了对医院获得性VTE危险因素的理解，以及如何将这些因素应用于儿童VTE预防的风险分层模式。在优化特殊人群（如新生儿和患有炎症性疾病的儿童）的传统抗凝治疗方面，以及在提高围手术期抗凝的总体安全性和依从性以及家庭国际标准化比值监测的使用方面，也有了更多见解。此外，TSOACs在儿童中的使用已有报道，并且是众多正在进行的临床试验的重点，这些试验正在评估这些药物在患有VTE的儿童中的安全性和有效性。
识别医院获得性VTE危险因素可能为儿童VTE预防策略提供依据。尽管TSOACs的初步使用可能很有前景，但仍在对其在儿童中的安全性和有效性进行研究。
