Pediatric venous thromboembolic disease in one single center: congenital prothrombotic disorders and the clinical outcome.
To learn more about the frequencies of congenital prothrombotic disorders in pediatric venous thromboembolism (VTE) and the outcome of this disease, we evaluated consecutive patients from 0 to 18 years with objectively diagnosed VTE at a single tertiary center over a 12-year period. We included 100 patients, with a median age at diagnosis of 1.0 year (range 2 days to 17 years). At least one underlying clinical condition was present in 96% of the patients. Factor (F)V G1691A mutation was present in 13%, FII G20210A mutation in 3%, antithrombin deficiency in 1%, protein C deficiency in 1% and protein S deficiency in 1% of the tested patients. Combined defects were present in 2.6% of the 77 patients with a complete work-up. Positive family history appeared to be the only predictor for positive testing for congenital disorders (OR 14.9, 95% CI 1.9-113). The overall mortality rate was 20%. The cumulative recurrence-free survival was 92% after 1 year of follow-up, and 82% after 7 years. The incidence and severity of the post-thrombotic syndrome was analyzed in a subgroup of 33 patients with VTE of the lower extremities. Twenty-three (70%) patients developed PTS: moderate in three and mild in 20 patients. In conclusion, congenital prothrombotic disorders seem to play a role in the development of pediatric VTE, and the risk of complications of this disease is high.
van Ommen
C H
CH
Department of Pediatrics (Pediatric Hematology), Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands. c.h.vanommen@amc.uva.nl
Heijboer
H
H
van den Dool
E J
EJ
Hutten
B A
BA
Peters
M
M
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005165:Factor V / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020125:Mutation, Missense; D020151:Protein C Deficiency; D018455:Protein S Deficiency; D011516:Prothrombin / Q000235:genetics; D012008:Recurrence; D016019:Survival Analysis; D013923:Thromboembolism / Q000150:complications / Q000209:etiology* / Q000401:mortality; D019851:Thrombophilia / Q000097:blood / Q000151:congenital* / Q000401:mortality; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000209:etiology* / Q000401:mortality
D005165:Factor V; D011516:Prothrombin