Management of Pediatric Patients with DVTs

General

• Obtain detailed history and physical examination, include weight.
• Contact the hematology consult service when the diagnosis is suspected.

Tests

• Impedance Plethysmography (IPG):  For early detection of the thrombus and follow-up.
• Duplex Ultrasound:    For early detection of the thrombus and follow-up.
• Venogram:  To determine the presence  and accurately determine the extent of the thrombus.

Note:  At the present time, only contrast venography is validated in the detection of DVT in children, particularly when suspected thrombus is in the upper limb.  DVT cannot be considered to have been ruled out until a negative venogram is obtained.  IPG and Doppler are non-invasive tests that may establish the diagnosis of thrombus, but are used primarily in following patients with established DVT.

• Ventilation-Perfusion (VQ) Scan:  Should be considered in all cases to determine if pulmonary emboli are present and for baseline assessment.

References

1.  Hirsh, H.  Heparin.  N Engl J Med 324(22):1565-1574.

2.  David, M., Andrew, M.  Venous thromboembolic complications in children.  J Pediatr 123(3):337-346.

3.  Andrew, M., David, M., Adams, M., Ali, K, Anderson, Barnard, D., Bernstein, M., Brisson, L., Cairney, B., DeSai, S., Grant, R., Israels, S., Jardine, L., Luke, B., Massicotte, P., Silva, M.  Venous thromboembolic complications (VTE) in children: First analysis of the Canadian Registry of VTE.  Blood 83(5):1251-1257, 1984.

4.  Andrew, M., Marzinotto, V., Pencharz, P., Zlotkin, S., Burrows, P., Ingram, J., Adams, M., Filler, R.  A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home.  J Pediatr 126:358-363, 1995.