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Anticlotting drugs rarely indicated for children with pelvic, femur fractures

Issue: August 10, 2012

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Michael C. Ain

Venous thromboembolism rates are so low in children with pelvic and femur fractures that anticlotting therapy should only be given to those children who are at an increased risk of clotting due to underlying conditions, according to study results from Johns Hopkins Children’s Center.

“Because we found clots are extremely rare in otherwise healthy children who suffer traumatic fractures, we believe anticlotting medications should be saved for those with underlying conditions like heart disease and cancer or some inherited conditions that make the blood more prone to clotting,” Michael C. Ain, MD, an associate professor of pediatric orthopedics at Johns Hopkins, said in a press release.

The study results suggest that preemptive anticoagulants should be reserved for children whose risk of clot formation outweighs their risk of bleeding associated with such drugs, according to researchers.

Ain and colleagues reviewed records of pediatric patients who had pelvic or femoral fractures between 1990 and 2009. They noted VTE and related mortality, as well as patient age, use of thromboprophylaxis and use of central venous catheters.

The researchers found three instances of deep vein thrombosis among the 1,782 patients studied (0.17%). There were no instances of pulmonary embolism or related mortality.

Medication was administered to 948 patients; 83 patients (8.8%) received thromboprophylaxis. Of the three children with a DVT, none had a central venous catheter, but 4% of the other patients did.

More than 91% of patients did not receive thromboprophylaxis, and there was no VTE-related morbidity or mortality when thromboprophylaxis was used, according to researchers.

“Weighing the unknown risk of blood clots against the risk of over-treatment is like solving an equation with two unknowns, but we hope our findings will provide some context and clarity for pediatricians in such situations,” Ain said.