How I Treat Pediatric Pulmonary Embolism.

Venous thromboembolism (VTE) affects approximately 1 in 200 hospitalized children. The diagnosis of pulmonary embolism (PE), the most severe clinical presentation of VTE, has increased dramatically by ~200% over the past two decades, disproportionately affecting adolescents, and is associated with adverse long-term post-PE sequelae. Nevertheless, the management of pediatric PE remains highly variable. This review focuses on significant advances in pediatric PE with a focus on published studies within the past decade. Using a representative case, we: (1) summarize existing risk prediction tools for acute pediatric PE and a shift in clinical practice in the management of acute PE with the implementation of pediatric PE Response Teams and multidisciplinary decision-making for severe pediatric PE; (2) describe recently completed clinical trials of anticoagulation in children and adolescents and ongoing work to elucidate the appropriate duration of therapy for children and adolescents with PE; (3) review advances in understanding post-PE syndrome and the need for continued refinement of evaluation tools and management approaches. Many unanswered questions remain despite the significant advances in pediatric thrombosis over the past decade.