5935 Venous thromboprophylaxis in children

Objectives To evaluate the incidence of paediatric venous thromboembolic events (VTEs) across university hospitals of Leicester trust. To analyse the risk factors preceding new thrombotic events to see if the implementation of a risk assessment and use of thromboprophylaxis in high-risk groups is necessary to reduce the incidence of VTE in children. Methods Retrospective data collection of 185 children for 24 months (January 2019 – December 2021) that have had requests for scans for potential VTEs from radiology reports, electronic notes, and clinic letters. Results Of 185 patients that had a scan to rule out VTE there were 43 positive VTEs. This ranged from 14 Cerebral Venous Thrombosis (CVTs), 9 Inferior Vena Cava/Superior Vena Cava (IVC/SVC), 8 Deep Vein Thrombosis (DVTs), 7 Pulmonary Embolism (PEs), 2 specifically line related and 3 other clots (e.g., Shano shunt clot, etc.). From the 43, 40 were associated with a known risk factor for VTE. We outlined in Graph 1 the risk factors associated with these provoked events. There were patients who had multiple risk factors present. VTEs were identified mainly in children 1 4 The reasons for these peaks are; higher number of CVCs in neonates and physiological changes in the coagulation systems of teenagers and an increase in risk factors such as; smoking, obesity, oral contraceptive pills.4 We have observed that a considerable proportion of paediatric patients diagnosed with a VTE had a cardiovascular history These patients have compounding risk factors for VTE such as: being post-operative, ICU care, immobile, and central lines. Analysis of treatment outcome revealed; 1 patient had persistent thrombosis present on the echo, 1 had post-thrombotic syndrome and 1 had multiple thrombosis even after completion of 3 months anticoagulation and subsequently required life-long anticoagulation. Conclusion In conclusion, similar to literature, VTE is rare in children.3 4 However, this is significantly increased in paediatric in patients. Those that occur are mostly within the neonatal or adolescent groups and are commonly provoked with compounding risk factors identified.2 Although most VTEs in children resolve completely without recurrence or complications, there are occasions when they can cause significant morbidity and even mortality. Therefore, we conclude that correct risk-stratification based on the identification of risk factors could help determine whether VTE prophylaxis should be implemented and reduce the incidence of provoked VTE. References Albisetti M, Chan AKC. Venous thrombosis and thromboembolism (VTE) in children: Treatment, prevention, and outcome Internet. UpToDate. cited 2022Nov21. Available from: https://www.uptodate.com/contents/venous-thrombosis-and-thromboembolism-vte-in-children-treatment-prevention-and-outcome?search=venous+thromboembolism+in+children19(9):305–12. Silvey M, Brandão LR. Risk factors, prophylaxis, and treatment of venous thromboembolism in congenital heart disease patients. Frontiers in Pediatrics. 2017;5. Monagle P, Cuello CA, Augustine C, Bonduel M, Brandão LR, Capman T, et al. American Society of Hematology 2018 Guidelines for management of venous thromboembolism: Treatment of pediatric venous thromboembolism. Blood Advances. 2018;2(22):3292–316.