Veneuze trombo-embolie bij kinderen: Diagnostiek, preventie en behandeling

An increasing number of children will need antithrombotic prophylaxis or therapy as result of the rising incidence of children with central venous catheters and chronic diseases. In the new guidelines of the Dutch Institute for Healthcare Improvement (CBO) special attention has been given to diagnosis, prevention and treatment of venous thromboembolic disease in children. In the upper venous system, diagnosis of venous thrombosis can be made by ultrasonography and/or venography. Ventilation-perfusion lung scanning or multi-detector computed tomography is used to detect pulmonary embolism. Deep vein thrombosis of the lower extremity can be diagnosed by ultrasonography. Children with central venous catheters do not need primary antithrombotic prophylaxis. However, prophylaxis can be considered in children with a previously diagnosed catheter-related thrombosis and children with total parenteral nutrition at home. Treatment of venous thromboembolism includes low-molecular-weight or unfractionated heparin, followed by vitamin K antagonists or low-molecular-weight heparin. The total duration of antitrombotic treatment is at least three months. To prevent post thrombotic symptoms, children with deep vein thrombosis of the leg should wear below-knee elastic compression stockings for a minimal duration of two years.