Pediatric Thromboembolism Treatment & Management
- Author: Scott C Howard, MD; Chief Editor: Robert J Arceci, MD, PhD more...
Medical Care
Initial care and evaluation for thromboembolism should occur in a pediatric inpatient ward or the ICU if severe respiratory distress or neurologic deterioration occurs. Management includes assessment of the extent of the thrombosis and clinical consequences, a search for thrombophilic risk factors, and anticoagulation therapy. The duration of anticoagulation depends on the extent and location of the thrombosis, whether the thrombophilic risk factors have resolved, and, in some cases, the degree of resolution for thrombosis after initial therapy (see Medication).[6, 7, 10, 11, 12, 13]
Surgical Care
On occasion, surgical thrombectomy may be necessary, especially after major cardiac surgery or if thrombolytic agents fail or are contraindicated.
Consultations
A pediatric hematologist should be involved in the care of all neonates, infants, and children with thromboembolism, and a pediatric neurologist should be involved in the care of children with suspected or proven CNS thrombosis.
Diet
Vitamin K directly interferes with the effectiveness of warfarin and potentially increases the risk for recurrent thrombosis. Daily intake of foods high in vitamin K, such as green leafy vegetables, should be kept at a consistent level. For example, patients should eat similar amounts of vitamin-K rich foods each day.
Maternal intake of vitamin K can also affect levels in breast milk and cause similar problems in neonates and infants. Supplementation with a consistent amount of formula per day has been recommended. Formula-fed infants should receive formula with the lowest concentration of vitamin K available. Vitamin K should be removed from parenteral nutrition or a constant small amount should be used each day.
Activity
Children with thromboembolism are sometimes restricted to bed rest for the first 24-48 hours to decrease the risk of pulmonary embolism (PE). However, this practice has never been shown to reduce the risk of embolization, and adults whose deep venous thrombosis (DVT) was treated as an outpatient (without bed rest) had no higher incidence of PE than those treated as an inpatient. Children with lower-extremity DVT should be fitted for compression stockings to reduce the risk of postthrombotic syndrome.
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