Abstract Number: OC 69.3
Meeting: ISTH 2021 Congress
Background: Abdominal thromboses are rare events in pediatrics and have not been well studied.
Aims: To describe the demographics, risk factors and outcomes for abdominal thromboses in a pediatric population.
Methods: This investigation was a retrospective analysis of a consented prospective inceptional cohort study. Clinical data, including age, gender, thrombosis site, underlying conditions, provoking factors, thrombophilia tests, recurrence and post thrombotic syndrome (PTS) symptoms, were extracted from the medical record. PTS determination included collateralization, varices, GI bleeding and organ dysfunction secondary to thrombosis and venous hypertension. Thrombophilia evaluations included antithrombin, protein C, protein S, factor V Leiden, prothrombin 20210, lipoprotein (a) and antiphospholipid antibodies (APA): the lupus anticoagulant, anticardiolipin antibodies (IgG, IgM, IgA) and anti-β2GP1 antibodies. Thrombophilia traits were either assayed clinically or in the Hemostasis Research Laboratory.
Results: Data on 44 pediatric patients, median age 9 years, range 0 to 22, with objectively confirmed abdominal thromboses comprised this analysis. Table 1 shows demographics of study participants. Renal and portal vein thrombosis predominated in both age groups, while older children additionally had more unusual locations. Recurrence rates were lower in the younger group and similar to rates for extremity thrombosis, but post thrombotic syndrome was prevalent in all ages with high prevalence at presentation. 50% of participants in both age groups had genetic thrombophilia with 25% having multiple traits. 50% of older children had APA and half of these had concurrent genetic thrombophilia. Table 2 displays underlying conditions and provoking factors. Infants had fewer identified underlying conditions; children and teens had primarily inflammatory or renal conditions.
| Entire Cohort (44) | <2 yo (14) | ≥2 yo (30) | |||||||
| Locations | Vein | Artery | Small vessel | Vein | Artery | Small vessel | Vein | Artery | Small vessel |
| Renal vessel | 18 | 2 | 1 | 8 | 1 | 0 | 10 | 1 | 1 |
| Portal | 17 | 5 | n/a | n/a | 12 | n/a | n/a | ||
| Other | 15 | 7 | 2 | 3 | 3 | 0 | 12 | 4 | 2 |
| Outcomes | <2 yo | ≥2 yo | |||||||
| Thrombus Recurrence | 1 | 10 | |||||||
| Post Thrombotic Syndrome | 8, 4 at time of presentation | 15, 11 at time of presentation | |||||||
| Genetic Thrombophilia | 8, including 1 with APA also | 15, including 6 with APA also | |||||||
| Antiphospholipid Antibodies | 1 APA alone | 7 APA alone | |||||||
Demographics: Pediatric Patients with Abdominal Thromboses
| Underlying Conditions | Entire Cohort (44) | <2 yo (14) | ≥2 yo (30) |
| Inflammatory Disorders | 24 | 0 | 24 |
| Renal disease including nephrotic syndrome | 4 | 0 | 4 |
| Diabetes and Metabolic Disease | 5 | 3 (gestational diabetes) | 2 |
| Splenectomy | 2 | 0 | 2 |
| Transient Risk Factors | Entire Cohort (44) | <2 yo (14) | ≥2 yo (30) |
| Transient APA, Infection or Sepsis | 26 | 6 | 20 |
| Solid organ transplant, surgery and/or catheter associated | 18 | 5 (catheter) | 13 |
| Perinatal accident | 3 | 3 | 0 |
| Steroid use | 8 | 0 | 8 |
Patient Underlying Conditions and Transient Risk Factors by Age
Conclusions: Children with abdominal thrombosis suffered significant morbidity acutely as well as recurrence and PTS. Understanding the clinical presentation and outcomes, including the high rate of genetic and acquired thrombophilia, is critical to better prevention and management of this condition and warrants further investigation.
To cite this abstract in AMA style:
Kuldanek S, Chan A, Thornhill D, Jacobson L, Baird C, Smith J, Shearer R, Manco-Johnson M. Abdominal Thromboses in Pediatric Patients: What Do we Know? [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/abdominal-thromboses-in-pediatric-patients-what-do-we-know/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/abdominal-thromboses-in-pediatric-patients-what-do-we-know/