Unresolved issues concerning venous thromboembolism. Venous thromboembolism in children. Consensus of the French Society of Vascular Medicine (SFMV)

Venous thromboembolism (VTE) rarely occurs during childhood and, with few exceptions, should be considered as a disease of sick children. Current recommendations concerning the duration of anticoagulant treatment for paediatric VTE are essentially based on the results of clinical trials conducted in adults. Yet the underlying medical conditions, incidence, and anatomical locations of the disease, as well as the rates of unprovoked VTE, morbidity, and mortality, differ between adults and children. Unprovoked VTE is uncommon in childhood. Most children experiencing VTE present risk factors, such as the presence of a central venous catheter (CVC), cancer, chemotherapy (in particular with asparaginase or steroids), obesity, severe infection, congenital cardiopathy (notably in conjunction with hepatic venous stasis), serious trauma, an anatomical venous anomaly (such as atresia or agenesia) or a nephrotic syndrome (inducing a deficit in antithrombin or protein S), premature birth, or maternal combined oral contraception. The recent possibility of administering direct oral anticoagulants (DOAC) to children undoubtedly constitutes the greatest change in the treatment of paediatric VTE. The advantages of this therapy include the possibility of its oral administration, even in infants, the absence of any need for laboratory follow-up, and the lack of food interactions. With the approval of the direct factor Xa inhibitor rivaroxaban (by the European Medicines Agency and Health Canada), and the direct thrombin inhibitor dabigatran (by the European Medicines Agency and the US Food and Drug Administration), paediatric anticoagulant therapy is changing. Only rivaroxaban currently has a Marketing Authorisation in France for the treatment of childhood VTE.