A multinational study of thromboprophylaxis practice in critically ill children

Edward Vincent S. Faustino, Sheila Hanson, Philip C. Spinella, Marisa Tucci, Sarah H. O'Brien, Antonio Rodriguez Nunez, Michael Yung, Edward Truemper, Li Qin, Simon Li, Kimberly Marohn, Adrienne G. Randolph

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Objectives: 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. Design: Prospective multinational cross-sectional study over four study dates in 2012. Setting: Fifty-nine PICUs in Australia, Canada, New Zealand, Portugal, Singapore, Spain, and the United States. Patients: 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. Interventions: None. Measurements and Main Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1232-1240
Number of pages9
JournalCritical care medicine
Volume42
Issue number5
DOIs
StatePublished - May 2014

Keywords

  • anticoagulants
  • deep venous thrombosis
  • heparin
  • pediatric intensive care unit
  • pulmonary embolism
  • venous thromboembolism

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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