Thromboprophylaxis for Critically Ill Adolescents: A Multicenter Case-Control Study From the Children's Healthcare Advancements in Thrombosis Consortium.

Objectives: To determine if thromboprophylaxis, including pharmacologic, mechanical, or in combination, is associated with a hospital-acquired venous thromboembolism (HA-VTE) risk reduction among critically ill adolescents.

Design: Multicenter case-control study from the Children's Healthcare Advancements in Thrombosis Consortium Registry and VTE risk-model validation study from January 2012 to July 2022.

Setting: Thirty-two North American PICUs.

Patients: Critically ill adolescents 12-19 years old including cases with radiographically confirmed HA-VTE (i.e., pulmonary embolism and deep venous thrombosis) and controls without HA-VTE.

Interventions: Pharmacologic (i.e., prophylactic anticoagulation) and mechanical (i.e., intermittent pneumatic compression) thromboprophylaxis.

Measurements And Main Results: Of 163 cases and 975 controls, 7.6% received pharmacologic, 23.5% mechanical, and 9.2% pharmacologic and mechanical thromboprophylaxis. Compared with controls, cases more frequently had central venous catheterization (89% vs. 21.1%), invasive ventilation (52.2% vs. 11.8%), longer median length of stay (29 d [interquartile range, 15-46 d] vs. 6 d [interquartile range, 3-10 d]), impaired mobility (72.6% vs. 22.1%), and infection (48.5% vs. 16%; all p < 0.001). Venous thromboembolism risk tiers (low, moderate, and high) were calculated using validated scoring criteria. Using multivariable logistic regression for HA-VTE risk accounting for additional prothrombotic covariates and among each VTE risk tier, pharmacologic and combined thromboprophylaxis, but not mechanical thromboprophylaxis alone, were independently associated with reduced HA-VTE risk.

Conclusions: Among critically ill adolescents, pharmacologic thromboprophylaxis alone or in combination with mechanical thromboprophylaxis, but not mechanical thromboprophylaxis alone, was associated with an HA-VTE risk reduction.