title: Risk factors and co-morbidities in adolescent thromboembolism are different than those in younger children.
abstract: BACKGROUND
  In adolescent thromboembolism (TE), multiple risk factors (RFs) and co-morbidities (CMs) are reported, though overall prevalence has not been evaluated. We hypothesized that the spectrum of RFs/CMs in adolescent TE differs from children overall and sought to review Texas Children's Hospital's experience.
  
  
  METHODS
  Medical records of adolescents aged 12-21years, diagnosed with arterial or venous TE (AT/DVT) from 2004 to 2014, were retrospectively reviewed and analyzed with IRB approval.
  
  
  RESULTS
  Sixty-four adolescents (median age 16, range 12-20years) met study criteria. Fifty-seven (89%) had DVT and six (9%) had AT. Associated RFs/CMs included obesity (47%), CVC (27%), infection (27%), surgery (27%), autoimmune disease (19%), immobility (22%), anatomical abnormality (20%), cancer (8%), estrogen therapy (6%), tobacco use (6%), trauma (3%), inherited thrombophilia (19%), and other medical conditions (11%). Fifty-two (81%) had ≥2 RFs/CMs. Therapy included anticoagulants, antiplatelet agents, and interventional therapy. Of those with follow-up imaging, 49 had complete or partial resolution, 5 had no change and 4 had progression. Fourteen (22%) had recurrent TE. The majority with recurrent TE (79%) had ≥2 RFs at initial diagnosis. Mean time to recurrence was 4.80years; time to recurrence was shorter for occlusive TE (p=0.026).
  
  
  CONCLUSIONS
  Adolescent TE is often multi-factorial with the majority having ≥2 RFs at diagnosis, suggesting the need for detailed evaluation for RFs in this population, which may enable optimal management including thromboprophylaxis, and institution of RF-modifying strategies to prevent occurrence/recurrence.
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Titilope
authors.initials: T
authors.lastname: Ishola
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Kirk
authors.affiliation: Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Guffey
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Voigt
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Mona D
authors.initials: MD
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Section of Hematology and Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. Electronic address: lvsrivat@txch.org.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Srivaths
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Adolescent; Deep vein thrombosis; Pediatrics; Risk factors; Thromboembolism