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Predictive risk factors for recurrent VTE in children

1University of Amsterdam, Amsterdam, Noord-Holland, Netherlands, 2Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands, Amsterdam, Noord-Holland, Netherlands, 3Emma Children's hospital/ Amsterdam University Medical Centers, Amsterdam, Noord-Holland, Netherlands, 4Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands, Amsterdam, Noord-Holland, Netherlands, 5Emma Children's Hospital/ Amsterdam University Medical Centers, Amsterdam, Noord-Holland, Netherlands

Abstract Number: OC 08.4

Meeting: ISTH 2022 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: A serious long term complication following venous thromboembolism (VTE) is recurrent thrombosis. Prolongation of the initial anticoagulant therapy is effective in reducing recurrent VTE, but associated with bleeding complications. Therefore, identification of the patients at risk of recurrent VTE is crucial to target prolonged anticoagulation in this specific group.

Aims: The primary aim of this study was to determine these risk factors and the secondary aim was to determine the incidence of recurrent VTE and recurrent-free survival

Methods: For this retrospective cohort study all children (0-18 years) with a VTE between 2000 and 2021 treated at Emma Children’s Hospital, Amsterdam UMC were eligible. The following determinants were studied: age, comorbidity, CVC, thrombusresolution, thrombophilic mutation, inflammatory status and thromboprophylaxis.

Results: During the observation period 703 patients were eligible and 637 (91%) are included in the current analysis. Recurrent VTE occurred in 134/637 patients (21%). Median age was comparable in the recurrence (4.5± 7.0 years) and non-recurrence group (4± 7.2 years). Most frequent comorbidity in recurrent VTE was total parenteral nutrition (TPN) (22.4%) and active malignancy (20.9%) compared to infection (21.9%) and active malignancy (20.3%) in patients without recurrence. The median time to recurrence was 182 days after the initial VTE. Risk factors significantly associated with recurrent VTE were lack of thrombus resolution (p=0.026, OR=4.6), TPN dependency (p=0.002, OR=59.7), active inflammation at time of VTE (p=0.011, OR=5.0) and the presence of a thrombophilic mutation (p=0.007, OR=0.182)

Conclusion(s): This study demonstrated a high recurrence rate, that was associated with the following determinants: lack of thrombus resolution, TPN dependency, active inflammation at time of VTE and the presence of thrombophilic mutation. These findings may aid in targeting more personalized treatment strategies in the future.

To cite this abstract in AMA style:

Laabar S, Fijnvandraat K, Rettenbacher E, Gouw S, Klaassen I. Predictive risk factors for recurrent VTE in children [abstract]. https://abstracts.isth.org/abstract/predictive-risk-factors-for-recurrent-vte-in-children/. Accessed October 1, 2023.

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