Management of venous thrombosis in the pediatric patient

Successful treatment of an adolescent patient with acute subclavian vein occlusion using the Cleaner thrombectomy device

Paget-Schroetter Syndrome is a rare condition characterized by the thrombosis of the axillary and/or subclavian vein due to repetitive activity of the upper extremity. This effect results in exertion-induced deep venous thrombosis (DVT) of the upper extremity. In the literature, it has been reported more frequently among the adult population. We aimed to introduce a 15-year-old female patient who suffered an acute DVT of the left upper extremity, and her successful treatment using the Cleaner thrombectomy device.

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital

BACKGROUND

Venous thromboembolism (VTE) - which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) - has been increasingly recognized in the pediatric population. The estimated incidence is 0.07-0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS).

OBJECTIVE

To characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome.

METHODS

Retrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years.

RESULTS

Eight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS.

CONCLUSIONS

Although uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.