Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children
Introduction: The incidence of thromboembolic (TE)-pediatric pulmonary embolism (PPE) is increasing. We sought to evaluate current practice patterns and gaps in the management of TE-PPE. Materials and methods: After Institutional Review Board approval, SurveyMonkey® questions were sent to members of the Pediatric/Neonatal Thrombosis and Hemostasis Subcommittee, of the International Society on Thrombosis and Haemostasis and the Hemostasis and Thrombosis Research Society. Results: Of 442 members of the two groups, 134 (30%) responded, and 125 (28%) complete responses were analyzed. Eighty percent practiced at a pediatric facility, 88% at academic centers, and 59% in the USA. Computed tomography pulmonary angiography (CTPA) was the preferred diagnostic modality (89%). D-dimer testing was variably used; 22% used clinical diagnostic prediction models and 8% had specific clinical care pathways for TE-PPE management. Prognostic stratification models were used to guide therapy by 4%. Indications for thrombolytic therapy varied considerably; 40% had a standardized protocol for thrombolysis, employing various modalities (45% systemic, 25% catheter-directed, 19% pharmaco-mechanical) and tissue plasminogen activator dose intensities. Duration of anticoagulation was variable with 58% prescribing anticoagulation for duration of > 3 months–6 months; 61% followed for long-term adverse outcomes. Conclusion: This multinational survey of thrombosis/hemostasis specialists mainly based at pediatric academic centers demonstrates that antithrombotic management of TE-PPE (including duration of anticoagulation and use/non-use of thrombolysis) varies considerably. Furthermore, standardized care pathways to facilitate acute evaluation and management decisions are in place in a minority of centers. These findings help to inform the design of future clinical trials in TE-PPE.
|Keywords||Pulmonary embolism, Children, Pediatric, Practice patterns|
|Persistent URL||dx.doi.org/10.1016/j.thromres.2019.08.002, hdl.handle.net/1765/122309|
|Journal||Thrombosis Research: vascular obstruction, hemorrhage and hemostasis|
Rajpurkar, M., Williams, S, Goldenberg, N.A., van Ommen, C.H, Chan, A.K.C., Thomas, R, & Biss, T. (2019). Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children. Thrombosis Research: vascular obstruction, hemorrhage and hemostasis, 183, 98–105. doi:10.1016/j.thromres.2019.08.002