title: Impact of persistent antiphospholipid antibodies on risk of incident symptomatic thromboembolism in children: a systematic review and meta-analysis.
abstract: The aim of this study was to estimate the impact of antiphospholipid (aPL) antibodies on the risk of incident thromboembolism (TE; arterial and venous) in children via meta-analysis of published observational studies. A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1966 to 2010 was conducted using keywords in combination both as MeSH terms and text words. Two authors independently screened citations and those meeting the a priori defined inclusion criteria were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, TE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed-effects or random-effects models. Of 504, 16 pediatric studies met the inclusion criteria. In total 1403 patients and 1667 population-based controls ≤18 years were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. Thus, data from arterial and venous TE were analyzed together. In addition, meta-regression analysis did not reveal statistically significant differences between site of TE, age at first TE, country, or publication year. A statistically significant association with a first TE was demonstrated for persistent aPL antibodies, with an overall summary ORs/CI of 5.9/3.6-9.7 (arterial 6.6/3.5-12.4; deep vein thrombosis 4.9/2.2-10.9). The present meta-analysis indicates that detection of persistent aPL is clinically meaningful in children with, or at risk for, TE and underscores the importance of pediatric thrombophilia screening programs.
authors.affiliation: The Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel.
authors.forename: Gili
authors.initials: G
authors.lastname: Kenet
authors.forename: Sofia
authors.initials: S
authors.lastname: Aronis
authors.forename: Yackov
authors.initials: Y
authors.lastname: Berkun
authors.forename: Mariana
authors.initials: M
authors.lastname: Bonduel
authors.forename: Anthony
authors.initials: A
authors.lastname: Chan
authors.forename: Neil A
authors.initials: NA
authors.lastname: Goldenberg
authors.forename: Susanne
authors.initials: S
authors.lastname: Holzhauer
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Janna
authors.initials: J
authors.lastname: Journeycake
authors.forename: Ralf
authors.initials: R
authors.lastname: Junker
authors.forename: Christoph
authors.initials: C
authors.lastname: Male
authors.forename: Marilyn
authors.initials: M
authors.lastname: Manco-Johnson
authors.forename: Patti
authors.initials: P
authors.lastname: Massicotte
authors.forename: Rolf
authors.initials: R
authors.lastname: Mesters
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
authors.forename: Heleen
authors.initials: H
authors.lastname: van Ommen
authors.forename: Leslie
authors.initials: L
authors.lastname: Rafini
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.forename: Guy
authors.initials: G
authors.lastname: Young
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nowak-Göttl
mesh_terms: D000293:Adolescent; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012306:Risk; D013923:Thromboembolism / Q000209:etiology*
chemical_list: D017152:Antibodies, Antiphospholipid