# Intermittent pneumatic compression thromboprophylaxis among critically ill children: a single-center retrospective cohort study

## TL;DR

This study found that intermittent pneumatic compression does not reduce the risk of blood clots in critically ill children.

## Contribution

The study provides new evidence on the lack of efficacy of IPC thromboprophylaxis in reducing HAVTE in critically ill children.

## Key findings

- IPC was prescribed to 18.7% of critically ill children but did not reduce HAVTE risk in high/moderate-risk groups.
- Only low-risk patients showed an association between IPC and HAVTE (OR: 6.3).
- Findings align with recent multicenter studies suggesting IPC may not be effective in preventing HAVTE in children.

## Abstract

Mechanical thromboprophylaxis, including intermittent pneumatic compression (IPC), is administered as primary prevention against hospital-acquired venous thromboembolism (HAVTE) in critically ill children without supportive evidence of VTE risk reduction.

We aimed to assess the association between IPC thromboprophylaxis and HAVTE in critically ill children.

This was a single-center, retrospective cohort study of children aged <18 years hospitalized in a pediatric intensive care unit from 2020 to 2023. Those with a VTE present on admission or receiving therapeutic anticoagulation were excluded. Patients were classified into HAVTE risk tiers (low, moderate, and high) using previously validated criteria. The primary outcome was radiographically confirmed HAVTE. For each HAVTE risk tier, logistic regression was employed to test associations between HAVTE and IPC thromboprophylaxis, reporting odds ratios (ORs) with 95% CIs.

Of 4440 children studied, 30 (0.7%) had a HAVTE diagnosed at a median of 4.2 (IQR: 2.9-8.3) days after hospitalization. IPC was prescribed for 831 (18.7%) children. No association between IPC and HAVTE was detected for patients classified as high risk (OR: 0.27; 95% CI: 0.1-1.4) or moderate risk (OR: 0.81; 95% CI: 0.23-2.82) for HAVTE but was detected for those classified as low risk (OR: 6.3; 95% CI: 1.7-23.7).

In this single-center cohort of critically ill children, IPC thromboprophylaxis was commonly prescribed but was not associated with HAVTE risk reduction among patients at high/moderate risk for HAVTE. These findings corroborate recent multicenter administrative database findings and underscore the need for risk-stratified clinical trials to evaluate the efficacy of IPC thromboprophylaxis in critically ill children.

•Critically ill children have increased risk of developing hospital-acquired venous thromboembolism (HAVTE).•We sought to determine if intermittent pneumatic compression (IPC) prevents HAVTE in children.•Among 4400 critically ill children, 18.7% were prescribed IPC and 0.7% developed HAVTE.•Accounting for prothrombotic risk factors, IPC was not associated with reduced HAVTE frequency.

Critically ill children have increased risk of developing hospital-acquired venous thromboembolism (HAVTE).

We sought to determine if intermittent pneumatic compression (IPC) prevents HAVTE in children.

Among 4400 critically ill children, 18.7% were prescribed IPC and 0.7% developed HAVTE.

Accounting for prothrombotic risk factors, IPC was not associated with reduced HAVTE frequency.