VTE prophylaxis safe to administer in high-risk paediatric trauma patients

Use of chemical venous thromboembolism (VTE) in paediatric trauma patients who meet the high-risk criteria is safe and does not appear to carry any risk of bleeding complications, according to a study.

The study included 460 high-risk paediatric trauma patients (median age 14.5 years, 68 percent male). The median Injury Severity Score (ISS) was 23, and the median number of high-risk factors was 3. 

Overall VTE rate, the primary outcome, was evaluated according to receipt and timing of VTE. The secondary outcome of VTE safety was assessed by bleeding or other complications from anticoagulation.

Of the patients, 251 (54.5 percent) received VTE; VTE was administered within 24 hours of admission in 62 (13.5 percent) patients. Those who received VTE after 24 hours were more likely to have a higher number of risk factors as well as higher ISS.

Patients who received chemical VTE after 24 hours had more high-risk factors and higher ISS. The most common reason for delayed chemical VTE was central nervous system bleed (120 patients; 30.2 percent).

A total of 28 VTE events were documented among 25 patients (5.4 percent), including one patient (1.6 percent) who received VTE within 24 hours, 13 (6.9 percent) who received VTE after 24 hours, and 11 (5.3 percent) who had no VTE (p=0.31).

The odds of VTE increased with a longer delay between admission and initiation of VTE (odds ratio, 1.01, 95 percent confidence interval, 1.00–1.01; p=0.01). None of the patients had bleeding complications while receiving VTE.