How I treat pediatric pulmonary embolism

Abstract Venous thromboembolism (VTE) affects ∼1 in 200 hospitalized children. The diagnosis of pulmonary embolism (PE), the most severe clinical presentation of VTE, has increased dramatically by ∼200% over the past 2 decades, disproportionately affecting adolescents, and is associated with adverse long-term post-PE sequelae. Nevertheless, the management of pediatric PE remains highly variable. This review focuses on significant advances in pediatric PE, with a focus on published studies within the past decade. Using a representative case, we: (1) summarize existing risk prediction tools for acute pediatric PE, and a shift in clinical practice in the management of acute PE with the implementation of pediatric PE response teams and multidisciplinary decision-making for severe pediatric PE, (2) describe recently completed clinical trials of anticoagulation in children and adolescents, and ongoing work to elucidate the appropriate duration of therapy for children and adolescents with PE, and (3) review advances in understanding post-PE syndrome, and the need for continued refinement of evaluation tools and management approaches. Many unanswered questions remain despite the significant advances in pediatric thrombosis over the past decade.