International Journal of Molecular Medical Science, 2025, Vol.15, No.2, 54-68 http://medscipublisher.com/index.php/ijmms 64 Thailand. Therefore, it can be concluded that the performance of children's VTE models studied in the United States may be affected in regions like Thailand. Since risk factors can be highly influenced by the environment and vary from region to region, a series of targeted strategies are needed to better adapt the model to different healthcare Settings (Sheng et al., 2022). First, region-specific risk factors should be incorporated. For example, in Southeast Asian countries, after in-depth study of the pathogenesis characteristics of local children VTE, blood hypercoagulability caused by tropical diseases and infection-related factors caused by differences in sanitary conditions can be included in the model. For example, in malaria-endemic areas, the effect of malaria infection on the blood system of children increases the risk of VTE and can be considered as an important risk factor. Secondly, variable weights should be optimized. The weights of existing risk factors should be re-evaluated according to regional differences. In Southeast Asia, where CVC usage is low, the weight of CVC in the model should be appropriately reduced, while the weight of factors more relevant to local conditions should be increased, such as the influence of local high incidence of congenital diseases on VTE. This needs to be achieved through big data analysis and local clinical studies to ensure that the model is more realistic. Finally, it is important to carry out multi-center research and model validation. Through cross-regional multi-center research, data from different regions such as Western and Southeast Asian countries are collected to jointly participate in model construction and verification. A number of representative medical centers in Southeast Asia and the West were selected to collect child VTE case data, and these rich data resources were used to optimize the model and verify and adjust it in different regions, so as to build a more universal model to ensure accurate prediction of VTE risk in different medical Settings. In addition, this study found that BMI could be used as a predictor in future VTE risk prediction models for children. In Sharathkumar et al. (2012) study, it was found that BMI is becoming one of the risk factors for children's VTE, especially in the adolescent group. Three studies from 2018 to 2024 (Cairo et al., 2018; Walker et al., 2021; Tiratrakoonseree et al., 2024), included heart disease and kidney disease as risk factors for children's VTE. According to research findings, childhood obesity increases the risk of cardiovascular and kidney diseases and can lead to increased blood viscosity, thereby increasing the likelihood of thrombosis (Varra et al., 2024). Furthermore, obesity has been classified as a fundamental disease by the World Health Organization (Leung et al., 2024). VTE is rare in healthy children but its incidence is increasing in children with underlying diseases (Witmer and Raffini, 2020). BMI is an objective indicator for evaluating childhood obesity and overweight. A study in the United States showed a significant association between obesity, overweight, and the diagnosis of venous thromboembolism in children aged 2 to 18, but further research is needed to fully define this relationship (Halvorson et al., 2016). Therefore, researchers are advised to increase research on the correlation between BMI and children's VTE. During the data extraction process, we found that age is the second largest predictor after CVC. In the study by Jaffray et al. (2021), 728 pediatric patients aged 0-21 with VTE were included, with <1 year olds and adolescents accounting for 39% and 34%, respectively. However, the study by Cairo et al. (2018) found that the probability of venous thromboembolism (VTE) in children aged 6 to 15 years is small, making age a difficult predictor in pediatric VTE risk prediction models. Based on this, we can infer that the neonatal period and adolescence are high-risk stages for pediatric VTE. The high incidence of VTE in neonates and infants is due to differences in their hemostatic systems. Neonates do not pass coagulation proteins through the placenta, leading to lower concentrations of procoagulants, along with factors such as the hypercoagulable state due to disease and increased invasive treatments. Therefore, special attention should be paid to the presence of risk factors such as sepsis, prematurity, and CVC during the care of children in this stage (Makatsariya et al., 2022). In neonates with sepsis, activation of leukocytes and platelets in the body can lead to venous stasis, keeping the blood in a hypercoagulable state and promoting the occurrence of VTE (Fort et al., 2022). Premature infants have lower levels of natural anticoagulants (such as antithrombin and
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