Tromboembolismo venoso em idade pediátrica: um olhar de 20 anos numa unidade de cuidados intensivos pediátricos

Abstract

OBJECTIVE: Clinical characterization and approach of patients with thromboembolism (VTE). METODOLOGY: Retrospective, descriptive study of patients aged <18 years with VTE in a pediatric intensive care unit in a tertiary care hospital over 20 years [2002-2021]. RESULTS: Identified 51 patients: deep vein thrombosis (DVT) (n=30), cerebral vein thrombosis (CVT) (n=21), pulmonary thromboembolism (PTE) (n=4), portal vein thrombosis (PVT) (n=2) and renal vein thrombosis (RVT) (n=1). In 5 patients CVT and DVT coexisted (n=1); PTE and DVT (n=3); and RVT and DVT (n=1). Mean 2.6 cases/year. 52.3% male, median 6 years [1M;17Y]. The presence of a central venous catheter was the main risk factor (72%) in DVT associated with edema in the region; Doppler ultrasound was the exam of choice. All with PTE were adolescents; 75% had chest complaints confirmed by angio-CT; identified =2 risk factors in each patient. The case of RVT was a 2-year-old child with renal neoplasm. The cases of PVT were adolescents with symptoms of portal hypertension. The main symptom in CVT was headache (63.6); 52.4% secondary to upper respiratory infection; thrombophilia study positive in 42.9%. Analytically, all had elevated D-dimers. Most started anticoagulation with enoxaparin (86.3%), which they maintained for 3 to 6 months after discharge. Mean hospital stay was 17.6 days. There was 1 episode of recurrence and 1 death unrelated to VTE. DISCUSSION: The presentation of thromboembolic phenomena is nonspecific and approach guidelines are scarce in Pediatrics. However, early detection is crucial to prevent complications.

Keywords

• venous thromboembolism
• upper extremity deep vein thrombosis
• pulmonary embolism
• pediatrics