[size=20px]A 13 year-old girl sustained a complicated pelvic fracture and had an external fixator placed. She is currently immobile. Her baseline body mass index (BMI) is 33 kg/m2 and she takes an oral contraceptive at baseline. Which of the following is the most appropriate strategy for VTE prophylaxis?

 

A Daily lower extremity duplex ultrasound

 

B Lower extremity sequential compression devices (SCDs)

 

C Lovenox 0.5 mg/kg q12h

 

D Placement of a removable IVC filter​[/size]

C

C

C

C

B

C

correct answer

C Lovenox 0.5 mg/kg q12h

 

Venous thromboembolism (VTE) is rare in pediatric surgical and trauma patients. However, some patients are at increased risk and may benefit from prophylaxis.​

 

​There are no absolute criteria that dictate the type of prophylaxis. Some children’s hospitals have used risk stratification strategies, such as the Venous Thromboembolism Risk Assessment (V-TRAS). This patient has multiple risk factors that place her at high risk for VTE, including immobility, pelvic fracture, obesity, and oral contraceptive use. In this case, pharmacologic prophylaxis with Lovenox (low molecular weight heparin) should be considered.​

 

Screening for VTE with duplex ultrasound is not recommended. Serial Compression Devices (SCDs) alone are not sufficient in high risk patients. Since this patient does not have a contraindication to anticoagulation, there is no indication for an inferior vena cava (IVC) filter. These devices are associated with a high rate of complications and are rarely used in pediatric surgical patients.​

 

Edited September 9, 20233 yr by Admin

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