Rate of Venous Thromboembolism in Pediatric Patients Increases During Seven-year Study

The incidence of venous thromboembolism (VTE) in pediatric hospitals has increased 70% over the past seven years, according to the results of a new study.

During the seven-year, multi-center study, researchers from the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine found that the annual rate of VTE increased from 34 cases per 10,000 patients to 58 cases per 10,000 patients from 2001 to 2007. Altogether, 11,337 hospitalized patients under the age of 18 were diagnosed with VTE during the course of the study. The increase in VTE cases was seen in neonates, infants, children, and adolescents, according to a Pediatrics article about the study, and “the majority (63%) of children with VTE had ≥1 coexisting chronic complex medical condition.”

“I don’t think we think there’s been a seven-fold increase,” said Janna Journeycake, MD, MSCS, director of the Hemophilia and Thrombosis Program at Children's Medical Center, University of Texas Southwestern Medical Center at Dallas. “It was there all along. We just didn’t know how to recognize it.”

The researchers also looked at what treatment options the children were given. Over the course of the study, according to the Pediatrics article, “the proportion of children with VTE who were treated with enoxaparin increased from 29% to 49% during this time period (P < .001); the use of warfarin decreased slightly from 11.4% to 9.6% (P = .02).” As patients who had suffered a VTE grew older, they were more likely to be treated with either enoxaparin or warfarin.

Mark Shen, MD, medical director of hospital medicine at Dell Children’s Medical Center in Austin, Texas, and pediatric editor of The Hospitalist, attributed much of the study results to the fact that there is an increased awareness of VTE in pediatric patients and of serious bone and joint infections that lead to more central lines, which is a risk factor for VTE.

“Before, we wouldn’t look for signs of a clot unless there were physical signs of swelling, discomfort, or shortness of breath,” Shen said. “Now we are much quicker to go and do an ultrasound or look for some kind of thromboembolism.”