Postthrombotic syndrome and other outcomes of lower extremity deep vein thrombosis in children

Abstract

Key Points• The frequency of PTS, PE, and DVT recurrence was higher in children with Non-LR DVT than in children with LR DVT.• Thrombus resolution, DVT triggering event, and sex were predictors of LE PTS in children.Pediatric lower extremity deep vein thrombosis (LE-DVT) can lead to postthrombotic syndrome (PTS) and other adverse events. We investigated the outcomes of LE-DVT in children. Three groups were compared: non-line-related (Non-LR) DVT, LR DVT in neonates (LR neonates ), and LR DVT in non-neonates (LR non-neonates ). A total of 339 children were included (Non-LR, n 5 56; LR neonates , n 5 95; and LR non-neonates , n 5 188). We found a statistically significant difference in the frequency of PTS (P 5 .04; 62.5%, 40.0%, and 46.3% in Non-LR, LR neonates , and LR non-neonates, respectively), of recurrent LE-DVT (P 5 .001; 10.7% and 2.0% in Non-LR and LR non-neonates, respectively), and pulmonary embolism (PE) (P < .001; 19.6% and 3.2% in Non-LR and LR non-neonates, respectively) among groups. There was no difference in DVT resolution (P 5 .41). Multivariable analysis showed that DVT resolution, triggering event, and sex predicted Modified Villalta Scale (MVS; for pediatric PTS) scores >1; there was an interaction between DVT triggering event and sex. The time to reach an MVS >1 was significantly different when comparing groups (log-rank test, P < .001). Moreover, we found a significant difference in baseline MVS scores among groups, but the difference did not appear to change over time. In conclusion, LR LE-DVT had more benign outcomes than Non-LR DVT. Sex, DVT triggering event, and DVT resolution predicted

Phase 3, single‐arm, multicenter study of dabigatran etexilate for secondary prevention of venous thromboembolism in children: Rationale and design

“…Estimates of the risks of VTE recurrence after an initial event in children vary8, 9; however, in children, as in adults, recurrence is associated with increased morbidity and mortality,1, 2, 6, 7 hence extended anticoagulant therapy may be warranted until VTE risk factors are resolved 1. Further, although estimates of rates of PTS in children vary considerably,7, 9, 10, 11 it has been found to be associated with increased morbidity and cost 39.…”

“…Further, although estimates of rates of PTS in children vary considerably,7, 9, 10, 11 it has been found to be associated with increased morbidity and cost 39. There have been far fewer studies on the natural history, treatment, and secondary prevention of VTE in children than in adults 1, 9, 40. Collaborative efforts between industry and academia, as in this study, are needed to enable the implementation of well‐designed, adequately powered trials that can address this lack of data and investigate potentially advantageous new anticoagulant options.…”

“…Anemia (hemoglobin <80 g/l) or thrombocytopenia (platelet count <80 × 109/l) at screening. Transfusions during the screening period are allowed, provided a satisfactory hemoglobin or platelet level is attained prior to visit 2…”

“…Estimates of the rate of pediatric VTE recurrence vary widely,6, 7 ranging between 2% and 21% 8. Post‐thrombotic syndrome (PTS), another long‐term consequence of VTE, has been reported in 12‐65% of children following an initial VTE 1, 7, 9, 10, 11, 12. Risk factors associated with VTE recurrence include underlying chronic conditions associated with a prothrombotic tendency, such as malignancies, cardiac/vascular abnormalities, short bowel syndrome with total parenteral nutrition dependency, or congenital disorders (eg, severe inherited thrombophilias).…”

The bottom (central) line in pediatric DVT

“…1 A lthough rarer than in adults, DVT is a growing problem in pediatrics, 2 as are its complications, which include postthrombotic syndrome (PTS), pulmonary embolism (PE), recurrence, and lack of thrombus resolution. However, in contrast to the growing evidence base for the disease in adults, 3 even basic knowledge regarding the frequency of such outcomes is sparse for pediatric DVT; available information is limited mostly to registry and case series data.…”