The use of thromboprophylaxis among adolescent patients with sickle cell disease (SCD) who were hospitalized shows signs of a steady increase, according to a study published in Blood Advances.
SCD creates a prothrombin state that increases the risk of venous thromboembolic events. Studies indicate that patients with SCD who were admitted to the hospital have a significantly higher risk of developing pulmonary embolism compared with healthy individuals. In addition, patients with SCD tend to suffer from thromboembolic events earlier than the general population.
Because of this increased risk, the American Society of Hematology recommends that critically ill patients with an acceptable risk of bleeding be prescribed venous thromboembolic prophylaxis. Although these guidelines do not specifically mention individuals with SCD, it is standard practice in some areas for thromboprophylaxis to be prescribed, despite the absence of clear standardized guidelines.
The authors of this study sought to understand the use of thromboprophylaxis (both pharmacological and nonpharmacological) among adolescent patients with SCD who were hospitalized. They gleaned data from the Pediatric Health Information Systems, a database that receives participation from 50 of the largest freestanding children’s hospitals in the United States. Using information obtained from this database, researchers were able to determine the frequency of thromboprophylaxis use among adolescent patients with SCD.
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During the period between January 2010 and June 2021, 7629 adolescents with SCD were admitted to 48 Pediatric Health Information Systems hospitals. Among these patients, pharmacological or mechanical thromboprophylaxis were used in 2600 admissions. The research team also noted an upward trend in the use of thromboprophylaxis—the figure rose from 1.3% of admissions in 2010 to 14.4% in the first half of 2021.
It is important to recognize that physicians often have to weigh the risk-to-benefit ratio of thromboprophylaxis in patients with SCD, given that it may increase the risk of bleeding. Therefore, the authors of the study believe that future work is needed to evaluate the safety of pharmacologic thromboprophylaxis among patients with SCD who are on aspirin or nonsteroidal anti-inflammatory drugs.
Davila J, Stanek J, O’Brien SH. Venous thromboembolism prophylaxis in sickle cell disease: a multicenter cohort study of adolescent inpatients. Blood Adv. Published online May 9, 2023. doi:10.1182/bloodadvances.2022007802