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Anti-clotting drugs rarely indicated for children with pelvic, femur fractures

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

“Because we found clots are extremely rare in otherwise healthy children who suffer traumatic fractures, we believe anti-clotting 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,” lead study author Michael C. Ain, MD, stated in a Johns Hopkins press release.

The study, published in the June issue of the Journal of Pediatric Orthopaedics, suggests that preemptive anticoagulants should be reserved for children whose risk of clot formation outweighs their risk of bleeding associated with such drugs, according to the release.

Ain and colleagues reviewed records for their pediatric patients having pelvic or femoral fractures between 1990 and 2009. They noted venous thromboembolism (VTE) and related mortality, as well as patient age, use of thromboprophylaxis and use of central venous catheters, according to the abstract.

The authors found three instances of deep vein thrombosis (DVT) among the 1,782 patients studied (0.17%), according to the abstract. There were no instances of pulmonary embolism (PE) or related mortality. Medication was administered to 948 patients; 83 patients (8.8%) received thromboprophylaxis. Of the 3 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, the authors reported.

“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 stated in the release.

Reference:

• Greenwald LJ, Yost MT, Sponseller PD, et al. The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures. J Pediatr Orthop. 2012. doi: 10.1097/BPO.0b013e31824b2a07.