Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children

M Rajpurkar; S Williams; N A Goldenberg; C H Van Ommen; A K C Chan; R Thomas; T Biss

doi:10.1016/j.thromres.2019.08.002

Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children

Thromb Res. 2019 Nov:183:98-105. doi: 10.1016/j.thromres.2019.08.002. Epub 2019 Aug 14.

Authors

M Rajpurkar¹, S Williams², N A Goldenberg³, C H Van Ommen⁴, A K C Chan⁵, R Thomas⁶, T Biss⁷

Affiliations

¹ Carman and Ann Adams Department of Pediatrics, Division of Hematology Oncology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, USA. Electronic address: mrajpurk@med.wayne.edu.
² Division of Pediatric Hematology/Oncology, Hospital for Sick Children, University of Toronto, Canada.
³ Divisions of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA; Johns Hopkins Medicine Pediatric Thrombosis Program, Johns Hopkins Children's Center, Baltimore, MD, USA.
⁴ Department of Pediatric Hematology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands.
⁵ McMaster Children's Hospital, McMaster University, Canada.
⁶ Carman and Ann Adams Department of Pediatrics: Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
⁷ Department of Hematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

PMID: 31675508
DOI: 10.1016/j.thromres.2019.08.002

Abstract

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: Children; Pediatric; Practice patterns; Pulmonary embolism.

Publication types

Multicenter Study

MeSH terms

Humans
Pulmonary Embolism / diagnosis*
Pulmonary Embolism / pathology
Pulmonary Embolism / therapy*
Surveys and Questionnaires
Thromboembolism / diagnosis*
Thromboembolism / diagnostic imaging*