The Initial Approach to Paediatric Thrombosis

Abstract

Venous thromboembolism (VTE) in children presents unique challenges distinct from adult thrombosis, primarily due to developmental differences in the haemostatic system and the rarity of traditional adult risk factors. Paediatric VTE is increasingly recognized, especially in neonates and adolescents, and is predominantly associated with underlying comorbidities such as central venous catheters (CVCs), cancer, or congenital heart disease. The concept of "developmental haemostasis" underscores the age-dependent evolution of coagulation, influencing both risk and management strategies.

Diagnosis relies on clinical signs and is confirmed via Doppler ultrasonography, MRI, or CT, depending on the site. Pulmonary embolism, though rare, requires prompt evaluation in cases of respiratory distress or collapse. Laboratory tests, including D-dimer, are less specific in children due to overlapping inflammatory conditions.

Anticoagulation therapy, typically initiated with heparinoids, must account for age-related pharmacokinetic differences and the risk of bleeding. Low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) are increasingly used, though evidence-based guidelines remain limited. Treatment duration and intensity are tailored to clinical context, with special considerations for asymptomatic CVC-related thrombosis and high-risk scenarios like neonatal renal vein thrombosis or purpura fulminans.

Thrombophilia testing is reserved for recurrent or unprovoked VTE, with genetic confirmation advised for severe deficiencies. While paediatric VTE management has advanced, ongoing research is essential to address unresolved questions and optimize evidence-based care, ensuring therapies align with the unique physiology of children.