Perioperative thromboembolism prophylaxis in children – is it necessary?

Perioperative antithrombotic prophylaxis in adults is widely recommended. In the past, it was believed that this does not concern the paediatric population. Recently, however, there has been growing evidence that the incidence of venous thromboembolism (VTE) in children is increasing and is probably underestimated. This is a result of advances in treatment of previously lethal conditions, wide use of central venous catheters, and improved awareness and diagnosis of VTE complications. However, large clinical trials assessing the efficacy and safety of antithrombotic treatment in children have not been conducted and there are not widely accepted protocols of perioperative prophylaxis. At the same time, there is a growing awareness of its sequelae: compartment syndrome, pulmonary embolism, pulmonary hypertension, post-thrombotic syndrome, cost, length of hospital stay, and mortality. Local recommendations based on observational studies, individual experience, and extrapolation from data of adults have emerged.