Thromboprophylaxis for Critically Ill Adolescents: A Multicenter Case-Control Study From the Children's Healthcare Advancements in Thrombosis Consortium.
Nikhil Vallabhaneni, Julie Jaffray, Brian R Branchford, Marisol Betensky, Amy Stillings, Emily Krava, Maua M Alleyne, Dina Ashour, Neil A Goldenberg, Anthony A Sochet
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引用次数: 0
Abstract
Objectives: To determine if thromboprophylaxis, including pharmacologic, mechanical, or in combination, is associated with a hospital-acquired venous thromboembolism (HA-VTE) risk reduction among critically ill adolescents.
Design: Multicenter case-control study from the Children's Healthcare Advancements in Thrombosis Consortium Registry and VTE risk-model validation study from January 2012 to July 2022.
Setting: Thirty-two North American PICUs.
Patients: Critically ill adolescents 12-19 years old including cases with radiographically confirmed HA-VTE (i.e., pulmonary embolism and deep venous thrombosis) and controls without HA-VTE.
Measurements and main results: Of 163 cases and 975 controls, 7.6% received pharmacologic, 23.5% mechanical, and 9.2% pharmacologic and mechanical thromboprophylaxis. Compared with controls, cases more frequently had central venous catheterization (89% vs. 21.1%), invasive ventilation (52.2% vs. 11.8%), longer median length of stay (29 d [interquartile range, 15-46 d] vs. 6 d [interquartile range, 3-10 d]), impaired mobility (72.6% vs. 22.1%), and infection (48.5% vs. 16%; all p < 0.001). Venous thromboembolism risk tiers (low, moderate, and high) were calculated using validated scoring criteria. Using multivariable logistic regression for HA-VTE risk accounting for additional prothrombotic covariates and among each VTE risk tier, pharmacologic and combined thromboprophylaxis, but not mechanical thromboprophylaxis alone, were independently associated with reduced HA-VTE risk.
Conclusions: Among critically ill adolescents, pharmacologic thromboprophylaxis alone or in combination with mechanical thromboprophylaxis, but not mechanical thromboprophylaxis alone, was associated with an HA-VTE risk reduction.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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