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Clinical Haematology

Thromboprophylaxis Guideline

  • Introduction

    Within adult health services, the need for treatment to prevent thrombosis (thromboprophylaxis) in ‘at risk’ populations (e.g. joint replacement surgery) is well recognised. There is less evidence defining paediatric populations at risk of thrombosis and even less evidence informing optimal treatment protocols. Nonetheless, there is a need to identify children and young people most at risk of thrombosis and implement appropriate thromboprophyalxis regimes. All Victorian Hospitals must have a formal thromboprophylaxis plan and RCH is no exception.

    This guideline provides recommendations for assessing thrombosis risk and implementing primary thromboprophylaxis strategies within the Royal Children’s Hospital. Primary thromboprophyalaxis refers to the treatment provided to patients who have not previously had a thrombosis but have an identifiable risk for such an event.

    Primary Prophylactic anticoagulation is recommended for the following conditions:

    • Prosthetic Valves
    • Pulmonary Hypertension
    • Cardiomyopathy
    • Post-Fontan surgery and patients with artificial conduits
    • Children with long term CVLs for infusion of TPN
    • Children admitted with major (>30%) burns who have a central venous line insitu.

    For all other clinical scenarios, pre-pubertal children rarely require thromboprophylaxis. However, there are some clinical indications where thromboprophylaxis may need to be considered. These include:

    • General/Medical Inpatient (prolonged hospital admission)
    • Surgical Inpatient
    • Oncology Inpatient

    Please refer to pdf for a guide to thromboprophylaxis assessment and management.

    References

    1. Arlikar S, Atchison C, Amankwah E, Ayala I, Barrett L, Branchford B, Streiff M, Goldenberg N. Development of a New Risk Score for Hospital-Associated Venous Thromboembolism in Criticially-Ill Children. Thrombosis Research. 2015;in press.
    2. Atchison C, Arlikar S, Amankwah E, Ayala I, Barrett L, Branchford B, Streiff M, Takemoto C, Goldenberg N. Development of a New Risk Score for Hospital-Associated Venous Thromboembolism in Noncritically Ill Children: Findings from a Large Single-Institution Case-Control Study. Journal of Pediatrics. 2014;165:793-8.
    3. Branchford B, Mourani P, Bajaj L, Manco-Johnson M, Wang M, Goldenberg N. Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation. Haematologia. 2012;97:509-15.
    4. Takemoto C, Sohi S, Desai K, Bharah R, Khanna A, McFarland S, Klaus S, Irshad A, Goldenberg N, Strouse J, Streiff M. Hospital-associated Venous Thromboembolism in Children: Incidence and Clinical Characteristics. Journal of Pediatrics. 2014;164:332-8.
    5. Amankwah E, Atchison C, Arlikar S, Ayala I, Barrett L, Branchford B, Streiff M, Takemoto C, Goldenberg N. Risk factors for hospital-associated venous thromboembolism in the neonatal intensive care unit. Thrombosis Research. 2014;134:305-9.
    6. Hanson S, Punzalan R, Christensen M, Ghanayem N, Kuhn E, Havens P. Incidence and Risk Factors for Venous Thromboembolism in Critically Ill Children with Cardiac Disease. Pediatric Cardiology. 2012;33:103-8.
    7. O'Brien S, Candrilli S. In the absence of a central venous catheter, risk of venous thromboembolism is low in critically injured children, adolescents and young adults: evidence from the National Trauma Data Bank. Pediatric Critical Care Medicine. 2011;12:251-6.
    8. Mahajerin A, Thornburg C. Hospital-Acquired Venous Thromboembolism in Children:Call-to-Action. Journal of Pediatrics. 2014;165:652-3.
    9. Jackson PC & Morgan JM. Perioperative thromboprophylaxis in children: development of a guideline for management. Pediatric Anesthesia. 2008: 18(6): 478-487
    10. Kahn SR et al. Prevention of VTE in non-surgical patients: Antithrombotic Therapy and Prevention of Thrombsois, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012. 141(2 Suppl): e195S-e226S.
    11. Gould MK et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombsois, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012. 141(2 Suppl): e227S-e277S.
    12. Falck0Ytter Y et al. Prevention of VTE in orthopaedic surgery patients. Antithrombotic Therapy and Prevention of Thrombsois, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012. 141(2 Suppl): e278S-e325S.
    13. Monagle P et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombsois, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012. 141(2 Suppl): e737S-e701S

    Disclaimer: This guideline was developed by clinicians within the Royal Children’s Hospital (Melbourne) to meet the need of our patient population. Adaptation of this guideline to other clinical settings should carefully consider the patient needs at that service.