Haematology Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia; Department of Nursing, The University of Melbourne, Australia.
Department of Paediatrics, The University of Melbourne, Australia; Haematology Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia.
Thromb Res. 2020 May;189:24-34. doi: 10.1016/j.thromres.2020.02.013. Epub 2020 Feb 19.
Asymptomatic venous thrombosis is a common complication among hospitalised paediatric patients. Previous guidelines recommend the treatment of all asymptomatic venous thrombosis, even when the diagnosis is made incidentally or the risk factor is no longer present. Whether clinicians need to treat all asymptomatic thrombosis in children, given the likelihood of long-term sequelae, is unclear and there are significant risks associated with anticoagulation treatment. Asymptomatic thrombosis in children is most frequently associated with central venous catheters (CVCs). The incidence of asymptomatic CVC-related VTE is highest in cohorts of children with cancer, but also reported in neonates, children with congenital heart disease and critically ill children. There is significant variation in reported rates of CVC-related thrombosis among cohorts of children with different underlying diseases and of various ages. As asymptomatic thrombosis is often an incidental finding, rates of asymptomatic VTE in children are most likely underestimated. Evidence about the incidence, characteristics and long-term outcomes associated with asymptomatic thrombosis in children often lacks precision as data is presented collectively with symptomatic thrombosis. This review discusses the current evidence pertaining to the necessity for screening for asymptomatic thrombosis, the risk benefit ratio of treatment and the risk of long-term morbidity. To confidently determine the clinical significance of asymptomatic VTE in children, prospective studies with extended follow up are needed.
无症状性静脉血栓形成是住院儿科患者的常见并发症。既往指南建议治疗所有无症状性静脉血栓形成，即使是偶然诊断或危险因素不再存在时。鉴于长期后遗症的可能性，临床医生是否需要治疗所有无症状性儿童血栓形成尚不清楚，抗凝治疗存在显著风险。儿童无症状性血栓形成最常与中心静脉导管（CVC）有关。在癌症患儿队列中，无症状 CVC 相关 VTE 的发生率最高，但也有报道见于新生儿、先天性心脏病患儿和危重症患儿。不同基础疾病和不同年龄的儿童 CVC 相关血栓形成的报告发生率存在显著差异。由于无症状性血栓形成通常是偶然发现，因此儿童无症状性 VTE 的发生率很可能被低估。与儿童无症状性血栓形成相关的发病率、特征和长期结局的证据往往缺乏准确性，因为数据是与有症状性血栓形成一起汇总呈现的。本文讨论了目前关于筛查无症状性血栓形成的必要性、治疗的风险效益比以及长期发病风险的证据。为了有信心地确定无症状性 VTE 在儿童中的临床意义，需要进行前瞻性研究并进行延长随访。
