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Screening tool could minimize risk of blood clots after pediatric orthopedic surgeries as well as lessen the burden of their treatment

three people in separate photos, one wears a lab coat, one on a black background and one outside

Researchers at the IWK are calling for a nationwide standard screening tool in an effort to reduce the instance of potentially dangerous blood clots from forming after pediatric surgeries. Venous thromboembolism (VTE), a term referring to blood clots in the veins, is a rare but potentially serious or life-threatening complication in pediatric ortho- surgical patients.

The study,  Venous Thromboembolism Prophylaxis Use by Pediatric Orthopedic Surgeons in Canada for the Pediatric Orthopedic Surgical Population was recently published in Cureus, Journal of Medical Science.

“VTE is one of the major and upcoming challenges facing the pediatric population,” says Dr. Ketan Kulkarni, IWK hematologist and Principal Investigator. “Children are not little adults, however, and adult protocols are not applicable to pediatric and adolescent populations.”

“Post operative blood clots are rare but dangerous events for children undergoing surgery,” says Dr. Ron El-Hawary, Chief of Orthopaedics at the IWK Health “It is an area which has not been fully studied, therefore standards have not been set. By providing nationwide guidelines for prevention of this complication, the risk of post-operative blood clots should be minimized.”

Thromboprophylaxis, the medical treatment to prevent the development of thrombosis, often means injections, possible pain and risk of bleeding. Not all children undergoing surgery need thromboprophylaxis as the risk of blood clots in pediatric patients is much lower than that in adults. Even fewer should need it after uniform protocol implementation. 

“This study builds on prior work done at the IWK that explored the effectiveness of a perioperative screening tool to guide VTE thromboprophylaxis practices in the pediatric orthopedic surgical population,” says Jenna Curwin Research in Medicine student. “There are risks associated with administering VTE pharmacologic prophylaxis and there are risks associated with missing patients who should be receiving these medications, so optimizing the use of VTE pharmacologic prophylaxis is important.”

“We developed a novel algorithm for screening for risk of VTE in ortho surgical patients,” says Kulkarni. “This was then universally implemented in IWK ortho patients (which is itself novel) and led to a 50 per cent reduction in use of thromboprophylaxis with no increase in VTE”

The tool is easy to use, reliable and can be administered bedside, before and after surgery by any health care provider. Thousands of patients could benefit each year.

Funding for this study came from JD Irving, the IWK Department of Diagnostic Imaging, The Doris MacKinnon Oncology Research Fund, the Canadian Thrombosis & Hemostasis Network and a scholarship from Research in Medicine (RIM).