Study: Anti-clotting drugs rarely needed in children with big-bone fractures

May 22, 2012

(Medical Xpress) -- Children with pelvic and thigh fractures develop dangerous blood clots so rarely that anti-clotting therapy should be given only to those with underlying conditions that increase clotting risk, according to a study from Johns Hopkins Children’s Center.

The research, to be published in the June issue of the Journal of Pediatric Orthopaedics, challenges several earlier reports that found a relatively high risk of developing dangerous clots deep inside the veins among pediatric patients. The new findings, the investigators say, suggest that preemptive anti-coagulant medications may be best reserved for children whose risk of forming a clot outweighs the small but very real risk of bleeding associated with anti-clotting drugs.

For the study, researchers reviewed 1,782 records of pediatric trauma patients treated at Hopkins between 1990 and 2009. Clots were reported in three children (0.17 percent), none of whom developed life-threatening complications.

The investigators say they believe their research is the first to evaluate clotting risk in healthy children with pelvic and thigh and should help clinicians better weigh the pros and cons of preemptive anti-clotting therapy. Anticoagulants have serious, if rare, side effects that include bleeding in the brain, stomach and other organs.

Anticoagulants are routinely given to adult trauma patients to prevent deep-vein clotting. Between 20 and 90 percent of adult trauma patients develop such blood clots, researchers estimate. Known as deep venous thrombosis, or DVT, such clots can travel to the lungs and cause pulmonary embolism, a potentially fatal condition that requires emergency treatment. Previous studies have found that between 4 and 22 percent of adult trauma patients with DVT progress to pulmonary embolism.

Because of this well-established risk, guidelines call for anti-coagulant therapy in all adult with bone fractures. But to date, scant data on clotting risk among children has rendered such decisions tricky, the researchers say.

“Weighing the unknown risk of blood clots against the risk of over-treatment is like solving an equation with two unknowns, but we hope that our findings will provide some context and clarity for pediatricians in such situations,” says study lead investigator Michael Ain, M.D., a pediatric orthopedic surgeon at Hopkins Children’s.

“Because we found that clots are extremely rare in otherwise healthy children who suffer traumatic fractures, we believe that 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,” adds Ain.

In the study, the three children with developed them in their femoral veins and were diagnosed by ultrasound prompted by symptoms suggestive of a blood clot. Such symptoms usually include leg pain and swelling or skin discoloration and warmth in the affected leg. Many people who develop DVT, however, have no symptoms, the research team cautions.

All three children with DVT were treated successfully with anti-clotting medication and none experienced complications from either the clot or the treatment. Thirty-one of the children in the study died, none of them of DVT-related complications. The most common causes of death were brain bleeding and brain swelling, secondary to traumatic brain injury.

Although 4 percent of the children (68) in the current study had a central venous catheter — a device believed to be the single most important DVT risk factor in otherwise healthy children — none of the three who developed DVT had such a device, the study found. Nine percent of patients in the study received preemptive anti-clotting therapy. There were no adverse effects among those who got anti-clotting medication.

Researchers emphasize that the low rate of DVT in the population they studied likely stems from the fact that most of the were healthy and had no underlying diseases that drive up clotting risk, such as congenital heart disease or cancer.

Explore further: Need a C-section? Protection from blood clot urged

Related Stories

Need a C-section? Protection from blood clot urged

August 29, 2011
(AP) -- New advice for pregnant women: If you're getting a C-section, special inflating boots strapped on your legs may lower the risk of a blood clot.

Common vein condition increases risk for developing life-threating blood clots

August 17, 2011
Patients with clinically diagnosed superficial vein thrombosis (SVT), a blood clot in the veins just beneath the skin that commonly resolves on its own without treatment, are four to six times more likely to develop venous ...

Recommended for you

Small drop in measles vaccinations would have outsized effect, study estimates

July 24, 2017
Small reductions in childhood measles vaccinations in the United States would produce disproportionately large increases in the number of measles cases and in related public health costs, according to a new study by researchers ...

At the cellular level, a child's loss of a father is associated with increased stress

July 18, 2017
The absence of a father—due to incarceration, death, separation or divorce—has adverse physical and behavioral consequences for a growing child. But little is known about the biological processes that underlie this link ...

New comparison chart sheds light on babies' tears

July 10, 2017
A chart that enables parents and clinicians to calculate if a baby is crying more than it should in the first three months of its life has been created by a Kingston University London researcher, following a study of colic ...

Blood of SIDS infants contains high levels of serotonin

July 3, 2017
Blood samples from infants who died of Sudden Infant Death Syndrome (SIDS) had high levels of serotonin, a chemical that carries signals along and between nerves, according to a study funded in part by the National Institutes ...

Is your child's 'penicillin allergy' real?

July 3, 2017
(HealthDay)—Many children suspected of being allergic to the inexpensive, first-line antibiotic penicillin actually aren't, new research indicates.

Probiotic supplements failed to prevent babies' infections

July 3, 2017
(HealthDay)—Probiotic supplements may not protect babies from catching colds or stomach bugs in day care, a new clinical trial suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.