Thrombosis in children and neonates: data from the RITI registry (Registro Italiano Trombosi Infantili)

Background The thrombotic disease of the newborn and the child is relatively rare compared to that of an adult. However, it is most frequently diagnosed today than in the past, especially in patients with acute illness also for greater awareness of the thrombotic complications that can occur(1). All forms of thromboembolism (TE) in both venous and arterial or intracardiac or atypical sites appear to be increasing for several reasons including i) the greater intensity of care and disposables put in place to support severe cases; ii) the widespread use of devices for vascular access; iii) typical risk factors which are more frequent in adulthood, today also present in childhood (the earliest use of oral contraceptives, obesity, sedentary lifestyle, etc). The diagnosis of TE in neonatal and pediatric patients is often particularly difficult because vascular diagnostic techniques have been almost exclusively validated in adults and diagnostic criteria extrapolated outright to child. Appropriate specific clinical trials for the diagnosis of TE in children are needed to validate these protocols. The natural history of the TE in the child is not completely elucidated yet. This fact has a significant practical implication in choosing whether and how to treat the thrombotic event. The event type (sometimes asymptomatic), the presentation (idiopathic or secondary), the evaluation of the risk factors predisposing to TE recurrence, the risk/benefit ratio of antithrombotic therapy, intensity and duration, the risk of bleeding related to treatment even if it is generally perceived as less relevant than in adults. The use of antithrombotic drugs in pediatric patients is different than in adults for many reasons, including the epidemiology of the TE, the fact that the hemostatic system in the child varies with age,the pharmacokinetics and pharmacodynamics of anticoagulants that also depends on age, the difficulty of the route of administration that can condition the choice of the drug, the absence of specific formulations for the pediatric age of most antithrombotic drugs, the diet that can strongly influence the absorption of drugs especially in the newborn, the compliance to therapy that may be suboptimal for several reasons related to the lack of understanding of the need for the therapy or emotional aspects in children