Characteristics of Upper and Lower Extremity Deep Vein Thrombosis and Predictors of Post-Thrombotic Syndrome in Children

Abstract

Background/aims: Our understanding of predictors of post-thrombotic syndrome (PTS) in children is evolving. The present study aimed to investigate differences in patient- and DVT-related characteristics between central venous catheter (CVC) and non-CVC-related thrombosis in children and to study early PTS predictors. Methods: Children aged 0-18 years were recruited ≥6 months after imaging-proven upper (UE) or lower extremity (LE) DVT. PTS was measured using CAPTSure©. Early predictors included age at DVT diagnosis, symptoms, DVT burden, and days on therapeutic anticoagulation within 30 days post-DVT. Analysis of predictors was stratified in CVC and non-CVC-related thrombosis. Generalized estimating equations were used for data analyses. Results: In total, 313 DVT-affected extremities of 256 patients were assessed; 275 (88%) DVT were CVC-related. Patients with non-CVC-related thrombosis were older (median 5.8 years, 25th-75th percentile 4.9-6.4 vs. 3.5 months, 25th-75th percentile 0.7-18.7, p<0.001), and had positive thrombophilia (64% vs 22%, p<0.001) and obesity (30% vs. 13%, p=0.01) more frequently than patients with CVC-related thrombosis. PTS CAPTSure© scores were 9.5 points higher (standard error 3.0, p=0.02) in the non-CVC-related thrombosis stratum. Age at the time of DVT predicted PTS in both strata; DVT burden and time from DVT diagnosis to PTS assessment predicted PTS in CVC-related thrombosis. Conclusions: PTS severity was higher in non-CVC-related than in CVC-related thrombosis. Increasing age at the time of DVT is associated with higher PTS severity. DVT burden and time from DVT diagnosis to PTS assessment are significant PTS predictors in CVC-related thrombosis, indicating that long-term follow up of these children is important.

Compression garments for the management of pediatric post‐thrombotic syndrome: A prospective longitudinal study

“…Median age at enrollment of the entire cohort was 13 years (25th-75th percentile 8-15 years); 53% (24/45) were male patients. Patients were enrolled in the study at a median of 6 years (25th-75th percentile 1-10 years) post-DVT diagnosis, which is in line with previous reports [1][2][3] suggesting that long-term follow-up of children with DVT to screen for PTS is warranted.…”

“…Median CAPTSure © score at enrollment was 31 points (25th–75th percentile 21–45). Of note, a CAPTSure © score ≥31 points represents moderate to severe PTS 3 . Median PODCI global functioning score at the time of enrollment was 88 points (25th–75th percentile 89–94 points), which is below the mean scores reported in healthy children (95–96 points, standard deviation 4–7 points) and below the median scores of children with limb DVT (94 points, 25th–75th percentile 87–98, in children with CVC‐related thrombosis and 97 points, 25th–75th percentile 92–99, in children with non‐CVC‐related thrombosis 3 ).…”

“…Of note, a CAPTSure © score ≥31 points represents moderate to severe PTS 3 . Median PODCI global functioning score at the time of enrollment was 88 points (25th–75th percentile 89–94 points), which is below the mean scores reported in healthy children (95–96 points, standard deviation 4–7 points) and below the median scores of children with limb DVT (94 points, 25th–75th percentile 87–98, in children with CVC‐related thrombosis and 97 points, 25th–75th percentile 92–99, in children with non‐CVC‐related thrombosis 3 ). Median satisfaction with PTS status at baseline was 3 points (25th–75th percentile 3–4 points), indicating that patient/caregiver satisfaction was neutral to somewhat dissatisfied with current PTS status.…”

“…Post‐thrombotic syndrome (PTS) is the most common long‐term complication of pediatric deep vein thrombosis (DVT) affecting the upper or lower extremities 1,2 . Approximately 2%–25% of children with limb thrombotic events develop moderate to severe PTS 1‐3 …”

“…1,2 Approximately 2%-25% of children with limb thrombotic events develop moderate to severe PTS. [1][2][3] Compression garments (CG) are the main modality for PTS management in adults and the only therapeutic alternative available in children. However, our knowledge on the effectiveness and…”