Vallabhaneni Nikhil, Jaffray Julie, Branchford Brian R, Betensky Marisol, Stillings Amy, Krava Emily, Alleyne Maua M, Ashour Dina, Goldenberg Neil A, Sochet Anthony A
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Medical College of Georgia, Augusta, GA.
Department of Pediatrics, University of California, San Diego, CA.
Pediatr Crit Care Med. 2025 Sep 1;26(9):e1126-e1137. doi: 10.1097/PCC.0000000000003788. Epub 2025 Jul 2.
To determine if thromboprophylaxis, including pharmacologic, mechanical, or in combination, is associated with a hospital-acquired venous thromboembolism (HA-VTE) risk reduction among critically ill adolescents.
Multicenter case-control study from the Children's Healthcare Advancements in Thrombosis Consortium Registry and VTE risk-model validation study from January 2012 to July 2022.
Thirty-two North American PICUs.
Critically ill adolescents 12-19 years old including cases with radiographically confirmed HA-VTE (i.e., pulmonary embolism and deep venous thrombosis) and controls without HA-VTE.
Pharmacologic (i.e., prophylactic anticoagulation) and mechanical (i.e., intermittent pneumatic compression) thromboprophylaxis.
Of 163 cases and 975 controls, 7.6% received pharmacologic, 23.5% mechanical, and 9.2% pharmacologic and mechanical thromboprophylaxis. Compared with controls, cases more frequently had central venous catheterization (89% vs. 21.1%), invasive ventilation (52.2% vs. 11.8%), longer median length of stay (29 d [interquartile range, 15-46 d] vs. 6 d [interquartile range, 3-10 d]), impaired mobility (72.6% vs. 22.1%), and infection (48.5% vs. 16%; all p < 0.001). Venous thromboembolism risk tiers (low, moderate, and high) were calculated using validated scoring criteria. Using multivariable logistic regression for HA-VTE risk accounting for additional prothrombotic covariates and among each VTE risk tier, pharmacologic and combined thromboprophylaxis, but not mechanical thromboprophylaxis alone, were independently associated with reduced HA-VTE risk.
Among critically ill adolescents, pharmacologic thromboprophylaxis alone or in combination with mechanical thromboprophylaxis, but not mechanical thromboprophylaxis alone, was associated with an HA-VTE risk reduction.
确定包括药物预防、机械预防或联合预防在内的血栓预防措施是否与危重症青少年医院获得性静脉血栓栓塞（HA-VTE）风险降低相关。
来自儿童血栓形成联盟登记处的多中心病例对照研究以及2012年1月至2022年7月的VTE风险模型验证研究。
32家北美儿科重症监护病房。
12至19岁的危重症青少年，包括影像学确诊为HA-VTE（即肺栓塞和深静脉血栓形成）的病例以及无HA-VTE的对照。
药物（即预防性抗凝）和机械（即间歇性气动压迫）血栓预防。
在163例病例和975例对照中，7.6%接受了药物预防，23.5%接受了机械预防，9.2%接受了药物和机械联合血栓预防。与对照相比，病例更频繁地进行中心静脉置管（89%对21.1%）、有创通气（52.2%对11.8%）、中位住院时间更长（29天[四分位间距，15 - 46天]对6天[四分位间距，3 - 10天]）、活动能力受损（72.6%对22.1%）以及感染（48.5%对16%；所有p < 0.001）。使用经过验证的评分标准计算静脉血栓栓塞风险等级（低、中、高）。在考虑额外促血栓形成协变量的情况下，对HA-VTE风险进行多变量逻辑回归分析，并在每个VTE风险等级中，药物预防和联合血栓预防，但不单独使用机械血栓预防，与降低HA-VTE风险独立相关。
在危重症青少年中，单独使用药物血栓预防或与机械血栓预防联合使用，但不单独使用机械血栓预防，与HA-VTE风险降低相关。
