Abstract Number: PB1311
Meeting: ISTH 2020 Congress
Background: Elevated plasma levels of markers of coagulation and inflammation, including D-dimer, factor (F)VIII, interleukin (IL)-6) have been identified as prognostic factors for post-thrombotic syndrome (PTS) in adults.
Aims: 1) To determine whether elevated plasma cytokine levels and a rise in plasma coagulability over the first 3 months post-diagnosis of deep venous thrombosis (DVT) in children are prognostic of PTS; 2) To investigate the relationship between elevated cytokine levels and increased plasma coagulability in pediatric patients with DVT.
Methods: We analyzed banked plasma biospecimens from NHLBI-sponsored multinational trial of anticoagulant treatment for provoked VTE in patients < 21 years old. All patients with an extremity DVT and PTS assessment at 1 year were included. Plasma coagulability was measured using the Clot Formation and Lysis (CloFAL) assay and cytokines levels were measured by multiplex immunoassay on plasma samples obtained at 6 weeks and 3 months post-DVT. Univariable and multivariable logistic regression were performed to test prognostic associations with PTS. Pearson correlation was used to test the association between cytokine levels and CloFAL assay measures.
Results: The study population consisted of 80 patients, median age 12.7 years. PTS developed in 34% (Table 1). After adjustment in a multivariable model, increase in area under the curve in the CloFAL assay (AUC60) between the 6 week and 3 month time points post-DVT remained a candidate (P=0.06) independent prognostic factor for PTS (OR=1.436, 95%CI=0.99-2.084). Levels of C-reactive protein, IL-6 and interferon gamma at 3 months post-VTE were significantly associated with increase in plasma coagulability as measured by CloFAL AUC60.
Conclusions: We have identified a rise in plasma coagulability during the first 3 months post-DVT diagnosis, as a candidate prognostic factor for PTS which may be driven by the time course of inflammatory response, as evidenced by elevated plasma levels in several cytokines.
To cite this abstract in AMA style:Betensky M, Amankwah E, Brandal S, Everett AD, Goldenberg NA. A Rise in Plasma Coagulability During the First 3 Months Following Provoked Venous Thromboembolism is Associated with the Development of Post-Thrombotic Syndrome in Children and Young Adults: Analysis of the Kids-DOTT Multicenter Trial-Derived Biobank [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-rise-in-plasma-coagulability-during-the-first-3-months-following-provoked-venous-thromboembolism-is-associated-with-the-development-of-post-thrombotic-syndrome-in-children-and-young-adults-analysis/. Accessed May 6, 2021.
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