A retrospective study of the factors associated with hypercoagulability in the pediatric patients at a tertiary care children's hospital.
OBJECTIVE
The objective of this study was to determine the risk factors of hypercoagulability in children. We explored the interaction of multiple risk factors with the incidence of thrombosis. Our hypothesis was that as the number of risk factors for thrombosis increased the actual incidence of thrombosis would also increase.


METHODS
Retrospective review from 2003 through 2006 based on a search using two electronic medical record databases.


METHODS
Pediatric Tertiary Care Children's Hospital.


METHODS
Two hundred twenty-six patients were identified and analyzed.


METHODS
Search terms included factor V Leiden polymerase chain reaction, prothrombin gene 20210A mutation, methylene tetrahydrofolate reductase mutation, antithrombin III, and protein C and S levels. Clinical data were compiled for regression analysis.


RESULTS
The presence of one risk factor was not significant. Two risk factors increased the risk of thrombosis (p = 0.005; OR 3.128). Three or more risk factors further increased the risk of thrombosis (p = 0.003; OR 4.861). Older age (>11 yrs) was protective against thrombosis (p = 0.007; OR 0.995), and the presence of a central venous catheter when analyzed against accumulating risk factors showed a higher risk than that found during the regression analysis (p = 0.001; OR 3.638).


CONCLUSIONS
The population at our institution is reflective of the previously reported standards for the genetic predispositions toward thrombosis. Although older age is associated with a lower incidence of thrombosis, the presence of a central venous access device is detrimental. Accumulation of factors results in an increased risk of thrombosis. This article suggests that when inserting a central venous access device, consideration of a hypercoagulation workup should occur. Those with any two or more risk factors, genetic or acquired, and the comorbidity of a CVL may warrant consideration for the institution of anticoagulation with an agent like low molecular weight heparin.
Slamon
Nicholas
N
Pediatric Critical Care (NS), Shand's Hospital/University of Florida, Gainesville, FL, USA. nslamonpeds.ufl.edu
Krueger
Leslie J
LJ
Edelson
Maureen
M
Glutting
Joseph J
JJ
Rittenhouse
David
D
D005165:Factor V / Q000235:genetics; D005787:Gene Frequency; D006776:Hospitals, Pediatric; D006801:Humans; D016015:Logistic Models; D008485:Medical Audit; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D015233:Models, Statistical; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D019851:Thrombophilia / Q000235:genetics / Q000503:physiopathology*; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology
C095381:factor V Leiden; D005165:Factor V; D042965:Methylenetetrahydrofolate Reductase (NADPH2)