Results from an Expert-Based Cross-Sectional National Survey on Antithrombotic TREATment After PEDiatric Peripheral Vascular Injuries. (The TREAT-PED-PVI Survey)

PURPOSE: We aimed to survey the contemporary approaches on antithrombotic drugs after major pediatric peripheral vascular injuries. METHODS: Using a web-based questionnaire, we engaged physicians involved in the surgical and medical treatment of pediatric peripheral vascular injury. The survey included 24 multiple-choice questions: 7 related to the baseline demographics of panelists, 10 related to the choice of antithrombotic treatment modalities according to different clinical scenarios, 3 related to safety and hemorrhagic complications, and 4 related to follow-up considerations. RESULTS: Of the 50 physicians invited, 35 (70%) gave their availability: 27 (77.1%) were vascular surgeons, 7 (20.0%) angiologists/cardiologists, and 1 (2.9%) pediatric specialist. The vascular surgeon oversaw the drug regimen choice in 28 (80.0%) institutions. Aspirin was the most frequently used antithrombotic agent in end-to-end anastomosis (n = 25, 71.4%) and interposition vein (n = 23, 65.7%) or prosthetic (n = 25, 71.4%) grafts. Aspirin was associated with low-weight molecular heparin either in end-to-end anastomosis or interposition vein graft (28.6%, both), with anticoagulants in interposition prosthetic graft (48.6%). The most frequent (42.0%) duration of treatment was 1 to 6 months. Only a minority (n = 9, 25.7%) used an integrated monitoring coagulation protocol. Bleeding disorders were not experienced by most (n = 29, 82.9%). CONCLUSION: Aspirin and low-weight molecular heparin are the most frequently used drug regimens after major pediatric vascular traumas, most frequently used in association. A multidisciplinary team evaluation is frequently adopted, but the vascular surgeon plays a major role in selecting the antithrombotic regimen.