Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Semin Thromb Hemost. 2021 Sep;47(6):631-642. doi: 10.1055/s-0041-1722847. Epub 2021 May 31.
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality among hospitalized patients, including children. In recent years, it has become clear that hospitalization and critical illness bestow an increased VTE risk in pediatrics and relate to mortality and life-limiting comorbidities. For critically ill children, reported rates of VTE vary by study sampling techniques, presence of inherited or acquired thrombophilia, acute and chronic immobility, underlying illness prompting hospitalization, and clinical factors related to illness severity such as central venous catheterization, length of stay, mechanical ventilation, and patient age. Accordingly, critically ill children with new signs of venous congestion, acute inflammation, or unexplained acute organ dysfunction should be routinely evaluated for VTE. This narrative review summarizes recent and historical literature regarding risk factors, prevention, presentation, treatment, and outcomes of VTE in critically ill children. In addition, we identify knowledge gaps and priorities for future collaborative research on this vital condition. Special attention is given to the clinical trial opportunities, challenges, and ongoing efforts in thromboprophylaxis in critically ill children, including those hospitalized for disease related to novel coronavirus (COVID-19) and multisystem inflammatory disease in children.
静脉血栓栓塞症（VTE）是住院患者（包括儿童）发病率和死亡率的主要原因。近年来，人们已经清楚地认识到，住院和重病会增加儿科患者的 VTE 风险，并与死亡率和限制生命的合并症有关。对于重症儿童，VTE 的报告发生率因研究采样技术、遗传性或获得性血栓形成倾向、急性和慢性活动受限、导致住院的基础疾病以及与疾病严重程度相关的临床因素（如中心静脉置管、住院时间、机械通气和患者年龄）而异。因此，对于有新的静脉充血、急性炎症或不明原因的急性器官功能障碍迹象的重症儿童，应常规评估 VTE。本综述总结了最近和历史上关于重症儿童 VTE 的危险因素、预防、表现、治疗和结局的文献。此外，我们确定了该重要疾病未来合作研究的知识空白和优先事项。特别关注重症儿童中血栓预防的临床试验机会、挑战和正在进行的努力，包括因新型冠状病毒（COVID-19）和儿童多系统炎症疾病住院的患者。
