Current practices in pediatric hospital-acquired thromboembolism: Survey of the Children's Hospital Acquired Thrombosis (CHAT) Consortium

for the CHAT Consortium Investigators, the VTE Risk Factors and Thromboprophylaxis Working Group of the Pediatric and Neonatal Thrombosis and Hemostasis Subcommittee of the ISTH SSC

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Abstract

Background: A rise in hospital-acquired venous thromboembolism (HA-VTE) in children has led to increased awareness regarding VTE prophylaxis and risk assessment. Despite this, no consensus exists regarding these practices in pediatrics. Objective: To describe common practices in VTE prophylaxis, VTE risk assessment models, and anticoagulation dosing strategies in pediatric hospitals that are members of the Children's Hospital Acquired Thrombosis (CHAT) Consortium. Methods: An electronic survey of 44 questions evaluating practices surrounding pediatric HA-VTE risk assessment and prevention was distributed between August 9, 2021, and August 30, 2021, to the primary investigators from the 32 institutions within the CHAT Consortium. Results: The survey response rate was 100% (n = 32). In total, 85% (n = 27) of the institutions assess HA-VTE, but only 63% (n = 20) have formal hospital guidelines. Within the institutions with formal guidelines, 100% (n = 20) include acute systemic inflammation or infection and presence of a central venous catheter (CVC) as risk factors for VTE. Pharmacologic prophylaxis is prescribed at 87% (28) of institutions, with enoxaparin being the most frequent (96%, n = 27). Variability in responses persisted regarding risk factors, risk assessment, thromboprophylaxis, dosing of prophylactic anticoagulation or anticoagulant drug monitoring. A majority of providers were comfortable providing thromboprophylaxis across all age groups. In addition, the global coronavirus disease 2019 increased the providers' use of prophylactic anticoagulation 78% (n = 25). Conclusion: Practices among institutions are variable in regard to use of HA-VTE prophylaxis, risk assessment, or guideline implementation, highlighting the need for further research and a validated risk assessment model through groups like the CHAT Consortium.

Original languageEnglish (US)
Article numbere12793
JournalResearch and Practice in Thrombosis and Haemostasis
Volume6
Issue number7
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
CMA received grant funding to support her fellowship training on the Research Training in Hematology grant from the National Institutes of Health National Heart, Lung, and Blood Institute (grant number 5T32HL007149). JJ received grant funding for this study from the National Institutes of Health from the National Center for Advancing Translational Science (grant number UL1TR001855), the Children's Hospital Saban Research Mentored Career Development Award and the Hemostasis and Thrombosis Research Society Mentored Research Award, supported by an independent educational grant from Takeda Pharmaceuticals U.S.A. The remaining authors have no relevant financial disclosures.

Publisher Copyright:
© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).

Keywords

  • anticoagulants
  • hospital
  • pediatric
  • risk assessment
  • risk factors
  • venous thromboembolism

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