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Thrombosis in Pediatric Patients with Intestinal Failure

April 26, 2023 7:00 am

G Keefe et al. J Pediatr 2023; 253: 152-157. High Rate of Venous Thromboembolism in Severe Pediatric Intestinal Failure

This retrospective study (n=263) examined the rate of venous thromboembolism (VTE) in pediatric patients who required parenteral nutrition for at least 90 consecutive days.

Key findings:

The cumulative incidence of VTE was 28.1%, with a rate of 0.32 VTEs per 1000 catheter-days
The number of catheters and early gestational age were noted to be independent risk factors for VTE
No patients had progression of thrombus while receiving therapeutic anticoagulation
Of those with acute DVTs (n=47), 24 (51%)resolved on repeat imaging, 14 (30%)were stable, and and 9 (19%) had decreased
4.4% (2 of 45) had a major bleed while on anticoagulation

The authors note that the true rate of VTE is likely even higher because only 42% categorized as not having a VTE had undergone dedicated venous imaging.

My take: A lot of patients with intestinal failure develop VTE. Given the risks of treatment, the role of prophylactic anticoagulation remains unclear. This is where a prospective study would be helpful.

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Thrombosis in Pediatric Patients with Intestinal Failure

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