PB0646 - What should be considered when choosing treatment for pulmonary thromboembolism in children?

Background: Although rare, cases with pediatric pulmonary thromboembolism (PT) appear to be increasing.Unfortunately, there is no guideline about PT treatment for the childhood period.

Aims: We aimed to find an answer to the question of which patient should be given thrombolytic therapy, and whether thrombolytic therapy should be applied just to the high-risk patients or low- and intermediate-risk patients could be a good candidate in the early period of PT.

Methods: There were 41 patients who diagnosed as PT between January 1, 2000 and December 31, 2022 were retrospectively analyzed and the median age at diagnosis was 169 months, there were 29 boys and 12 girls.

Results: PT mostly originated from the deep venous system (n=20;48%) while the initial diagnosis was isolated pulmonary embolism in 11 patients and two of these patients were later diagnosed as Behcet's disease. It was observed that LMWH or unfractionated heparin was used most frequently in the treatment and thrombolytic therapy (TPA) was given in 18 patients (43%). If the patient is symptomatic, if massive PT is present, if renal venous thrombosis and/or inferior vena cava and superior vena cava are accompanied by large segment thrombosis, if thrombosis is in the main pulmonary artery branches and if the patient is hemodynamically unstable, thrombolytic therapy followed by anticoagulation were given, excluding the cases with thrombocytopenia and/or a suspicion of infective endocarditis. It was observed that if there was a filling defect in the distal segmental artery branches and the patient was asymptomatic, anticoagulation without TPA was given. TPA was applied to10 patients who were asymptomatic and hemodynamically stable but had thrombus in the main pulmonary artery and all of them completely recovered.

Conclusion(s): In conclusion, children with PE, hemodynamic deterioration of the patient should not be expected for thrombotic therapy and it can be safely use in selected patients.