Current treatment practices of venous thromboembolism in children admitted to pediatric intensive care units

Objective: To describe current treatment practices of VTE in patients admitted to a pediatric intensive care unit (PICU) and compare these practices to published guidelines. Background: While the incidence of VTE is increasing, current treatment practices of VTE in patients admitted to PICUs are not known. Methods: This multicenter, prospective, observational study enrolled patients with confirmed VTE admitted to 11 PICUs over a rolling 6‐month study period. Treatment data were collected and analyzed. Results: Sixty‐six VTEs occurred in 6653 patients. Empiric treatment for VTE was initiated in 30% prior to VTE confirmation, and children with cyanotic heart disease were 15.7 times more like to receive empiric therapy. Overall, 78% received systemic anticoagulation, 8% treated with only catheter‐based interventions, and 13% of VTE were not treated. Seven patients (11%) underwent systemic fibrinolysis; more commonly in neonates (23%) vs children (5%). Surgical and interventional procedures were performed on 4 patients. The American College of Chest Physicians recommendations were incompletely followed. Only 28% of the 32 cases treated with low molecular weight heparin titrated dosing to a goal anti‐FXa level 0.5–1. Five of the 15 cases treated with unfractionated heparin titrated dosing to aPTT 60–90, and one case did not use goal‐directed therapy. Conclusions: Confirmed VTEs in patients admitted to PICUs are most frequently treated with systemic anticoagulation; however, more intensive treatments such as systemic thrombolysis and surgical or interventional procedures are not uncommon in this critically ill population. Current practices deviate from the published antithrombotic guidelines developed for the general pediatric population.