Acute Prognostic Factors for Post-Thrombotic Syndrome in Children with Limb DVT: A Bi-Institutional Cohort Study

Lyle, Courtney A.; Gibson, Elizabeth; Lovejoy, Amy E.; Goldenberg, Neil A.

doi:10.1016/j.thromres.2012.10.012

Cited by 23 publications

(31 citation statements)

References 12 publications

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“…Importantly, the results of available pediatric studies have not agreed on the role of elevated FVIII elevation as a risk factor for PTS. [42][43][44] The frequency of DVT resolution observed here is similar to that previously reported among pediatric patients with non-central nervous system venous thrombosis 45,46 and among children with arterial and venous thrombosis treated with standard anticoagulation. 47 Thrombolysis did not result in a significant difference in DVT resolution in our study.…”

Section: Ue-dvtsupporting

confidence: 87%

Postthrombotic syndrome following upper extremity deep vein thrombosis in children

Avila¹,

Duan²,

Cipolla³

et al. 2014

Blood

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Key Points• Upper limb PTS in children depends on DVT pathogenesis (primary vs secondary) and on the age of the patient (neonates vs non-neonates).• DVT pathogenesis and thrombus resolution are independent predictors of upper limb PTS in children.Despite its relatively estimated high occurrence, the characterization of pediatric upper extremity deep vein thrombosis (UE-DVT) and of UE postthrombotic syndrome (PTS) is still lacking. We investigated the occurrence, characteristics, and predictors of UE-PTS in a cohort of children with objectively confirmed UE-DVT. Patients were analyzed in 3 groups according to DVT pathogenesis and neonatal status: primary (G1), secondary neonates (G2 neonates ), and non-neonates (G2 non-neonates ). A total of 158 children (23 G1, 25 G2 neonates , and 110 G2 non-neonates ) were included. The most common triggering factors were effort-related (87%) in G1 and central lines in G2 neonates (100%) and in G2 non-neonates (92%). PTS scores ‡1, as per the Modified Villalta Scale, were identified in 87% of primary patients, 16% of G2 neonates , and 49% of G2 non-neonates . Survival analysis showed that the time to PTS score ‡1 significantly differed among group (log-rank test P < .0001).A multivariable logistic regression showed that DVT pathogenesis and imaging-determined degree of thrombus resolution at the end of therapy were independent predictors of a PTS score ‡2. In conclusion, pediatric UE-PTS frequency and severity depend on UE-DVT pathogenesis (primary/secondary) and, within the secondary group, on patient's age. Line-related UE-PTS has a more benign course, particularly in neonates. (Blood. 2014;124(7):1166-1173

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Section: Ue-dvtsupporting

confidence: 87%

Postthrombotic syndrome following upper extremity deep vein thrombosis in children

Avila¹,

Duan²,

Cipolla³

et al. 2014

Blood

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“…Only 1 prospective study has subsequently been published, in which the cumulative incidence of PTS was 23% after a follow-up period ranging from 1 to 5 years. 174 Variation in estimates of PTS frequency across studies may be attributable to the heterogeneity of study designs and methods of PTS measurement and variable intervals from DVT occurrence to PTS assessment. In addition, although a recent retrospective study suggested that change in PTS severity (as measured by modified Villalta score) is common over time, 175 it is unclear whether this is a true reflection of natural history or is explained by poor testretest reliability of the instrument itself.…”

Section: Pediatric Ptsmentioning

confidence: 99%

“…172 Recently, a 2-institution cohort study reported preliminary findings that the acute presence of the lupus anticoagulant (assessed by dilute Russell viper venom time) was associated with a significantly increased risk of clinically significant PTS. 174 As a result of the paucity of studies in this area, it is not possible to make specific recommendations on the prevention or treatment of pediatric PTS. Please refer to the Importance of Primary and Secondary Prevention of DVT to Prevent PTS and the Optimizing Anticoagulation Delivery to Prevent PTS sections for general approaches to preventing PTS.…”

Section: Pediatric Ptsmentioning

confidence: 99%

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

Kahn¹,

Comerota²,

Cushman³

et al. 2014

Circulation

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410

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“…21,22 This instrument was adapted from the Clinical-Etiologic-Anatomic-Pathophysiologic classification, an adult scale, and has been used in several pediatric studies, involving over 100 patients. [22][23][24][25] This scale also incorporates the child-friendly Wong-Baker pain rating in its assessment of symptoms of PTS. This scale has been validated for both upper and lower extremity PTS in children.…”

Section: Pts Scalesmentioning

confidence: 99%

“…Patients with any 1 abnormality (sign or symptom) are classified as having PTS, and those with both an abnormal sign and symptom are classified as having clinically significant PTS. 25 …”

Section: Pts Scalesmentioning

confidence: 99%

Comparison of 3 Postthrombotic Syndrome Assessment Scales Demonstrates Significant Variability in Children and Adolescents With Deep Vein Thrombosis

Raffini

Davenport²,

Bevilacqua³

et al. 2015

Journal of Pediatric Hematology/Oncology

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Postthrombotic syndrome (PTS) is an important outcome in children with deep vein thrombosis (DVT). There are several instruments to measure PTS, and no accepted "gold standard." The objective of this cross-sectional prospective study was to compare the prevalence of PTS in patients above 8 years old with a history of DVT using 3 scales: the Villalta scale, a pediatric modification of the Villalta scale, and the Manco-Johnson instrument. Forty-four subjects (22 females) were enrolled; mean age 16.6 years (SD 3.6 y). The majority had a lower extremity DVT. The average duration from DVT to PTS assessment was 2.6 years. The proportion of subjects with PTS using the adult Villalta scale was 11%, which was significantly less than the 66% of patients identified using both pediatric scales (P<0.0001). The majority of patients with PTS as determined by the pediatric scales had mild PTS. There was significant discordance between the prevalence of PTS using the Villalta scale compared with the 2 pediatric scales. This is especially relevant when considering which instrument to use in adolescent patients. This study demonstrates that PTS, as defined by these scales, is not a well-defined or standardized outcome, particularly when comparing adult and pediatric instruments.

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Acute Prognostic Factors for Post-Thrombotic Syndrome in Children with Limb DVT: A Bi-Institutional Cohort Study

Cited by 23 publications

References 12 publications

Postthrombotic syndrome following upper extremity deep vein thrombosis in children

Postthrombotic syndrome following upper extremity deep vein thrombosis in children

The Postthrombotic Syndrome: Evidence-Based Prevention, Diagnosis, and Treatment Strategies

Comparison of 3 Postthrombotic Syndrome Assessment Scales Demonstrates Significant Variability in Children and Adolescents With Deep Vein Thrombosis

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