Risk Factors and New Treatment Options in Pediatric Venous Thromboembolism

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Background

Pediatric venous thromboembolism (VTE) is a rare and heterogeneous disease. In most cases, VTE occurs in thrombotic risk settings as severe underlying diseases or intensive care treatments. Risk profiles, as well as thrombosis locations, vary largely with age. More than 90% of neonatal thromboses are associated with central venous catheters and the majority is found in abdominal veins and right atrium. In contrast, almost 50% of VTE in children between the ages of 2-12 are located in the cerebral sinus veins. From adolescence, thrombosis occurs increasingly in the upper and lower extremities, risk factors as May Thurner Syndrome emerge.

With new diseases as COVID 19, which have shown to be associated with thrombotic complications in adults, questions of strategies for thrombosis prophylaxis in children and adolescents with COVID 19 arise. While treatment options so far have mainly consisted of heparin or vitamin K antagonists, direct oral anticoagulants are available for the treatment of VTE. However, real world experiences are scarce, safety and efficacy of direct oral anticoagulants in high-risk patient groups as cancer, renal insufficiency or neonates still have to be determined. In addition, interventional procedures as catheter directed thrombolysis or thrombectomy are increasingly used in selected patient groups in pediatrics, thanks to improved techniques and specialized treatment centers.

The purpose of this Research Topic is to provide an overview of the knowledge gained on pediatric venous thromboembolism and associated risk factors during the last years and its implications on management. Which risk factors are important in the development of VTE in neonates and children; is it possible to prevent VTE in pediatric patients with these risk factors; and what is the management of VTE in these patient groups?
By presenting high-risk medical issues we want to foster adapted strategies in prophylaxis, diagnosis and treatment, including new treatment options as direct oral anticoagulants and interventional treatment options. Finally, we want to point out gaps in current knowledge and thus offer the basis for conception of further research studies.

The Topic Editors welcome researchers to submit reviews or original research articles about risk factors and new and/or alternative treatment options for VTE in in all types of VTE in neonates, children and adolescents. We want to focus on differences with regard to age, underlying risk factors/ diseases and treatment options. We plan to include thrombosis high risk medical issues as cancer, inflammatory disease including antiphospholipid syndrome, chronic inflammatory bowel disease, and COVID 17 associated diseases. We present new treatment options, including direct oral anticoagulants with focus on specific patients groups and interventional approaches for specific thrombotic diseases.

Keywords: Venous thrombosis, risk factor, direct oral anticoagulants, thrombolysis, pediatric

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