Logo image
Back
Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review
Journal article   Open access   Peer reviewed

Epidemiology and outcomes of clinically unsuspected venous thromboembolism in children: A systematic review

Anjali A Sharathkumar, Tina Biss, Ketan Kulkarni, Sanjay Ahuja, Matt Regan, Christoph Male, Shoshana Revel‐Vilk and SSC Subcommittee on Pediatrics and Neonatal T&H of the ISTH
Journal of thrombosis and haemostasis, Vol.18(5), pp.1100-1112
05/2020
DOI: 10.1111/jth.14739
PMCID: PMC7192773
PMID: 31984669
url
https://doi.org/10.1111/jth.14739View
Published (Version of record) Open Access

Abstract

Background Clinically unsuspected venous thromboembolic events (uVTE) detected during routine imaging pose a management challenge due to limited knowledge about their clinical significance. Unsuspected VTE are often referred as “asymptomatic,” “incidental,” or “clinically silent/occult” VTE. Objective To understand the epidemiology, management, and outcomes of uVTE in children. Methods A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. The search criteria included controlled vocabulary and keywords for VTE, incidental findings, and children (ages ≤ 21 years). Results Among 10 875 articles, 51 studies (8354 children with 758 uVTE) were selected. The studies were heterogeneous, I2 96%; P < .0001. Unsuspected VTE were diagnosed in two settings: first, asymptomatic VTE (aVTE) diagnosed through surveillance imaging for VTE (46 studies; n = 5894; aVTE: 715, pooled frequency: 19%, 95% confidence interval [CI]: 13%‐24%); second, incidental VTE (iVTE) diagnosed during imaging performed for indications without primary suspicion for VTE (6 studies; n = 2460; iVTE: 43). The majority (94%) of aVTE were associated with central venous lines (CVL). Non‐CVL settings included post‐spinal surgery, post‐splenectomy, trauma, nephrotic syndrome, and newborns. In general, aVTE were reported to have a benign clinical course, were mostly transient, and resolved without intervention and with few immediate or long‐term functional complications. Incidental VTE were primarily detected in children with cancer and ranged from tumor‐associated thrombi to pulmonary embolism (PE) with insufficient evidence to draw meaningful conclusions about their management. Conclusion Clinically uVTE were predominantly diagnosed with CVL and their outcomes were generally favorable implying limited benefit of routine surveillance and thromboprophylaxis. Prospective research is needed to clarify the optimal management of iVTE.
 asymptomatic venous thromboembolism unsuspected venous thromboembolism venous thromboembolism central venous line incidental venous thromboembolism pediatric

Details

Metrics

22 Record Views
31 Times Cited - Web of Science
Logo image