title: Impact of high risk thrombophilia status on recurrence among children and adults with VTE: An observational multicenter cohort study.
abstract: Antithrombin [AT]-, protein C [PC]- or protein S [PS]-deficiency [D] constitutes a major risk factor for venous thromboembolism [VTE]. Primary study objective was to evaluate if the clinical presentation at first VTE onset differs between children and adults and to compare the individual recurrence risk among patients with respect to age at onset and their thrombophilia status ATD, PCD or PSD.
  
  
  
  In 137 of 688 consecutively enrolled pediatric and adult VTE patients we calculated the absolute risk of VTE recurrence and event-free-survival adjusted for thrombophilia and positive family VTE history. At first VTE children manifested i) with a lower rate of pulmonary embolism, ii) a higher rate of cerebral vascular events or multiple VTEs, and iii) showed a higher proportion of unprovoked VTE compared to adolescents and adults. Adult patients reported more often a positive VTE history compared to younger study participants. The adjusted odds of recurrence in adults was 2.05 compared to children.
  
  
  
  At disease manifestation children and adults differ with respect to i) thrombotic locations, ii) percentage of unprovoked versus provoked VTE, and iii) different rates of positive VTE family histories. Furthermore, adults showed a two-fold increase risk of VTE recurrence compared to children.
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Kiel, Germany.
authors.forename: Gloria
authors.initials: G
authors.lastname: Brüwer
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Kiel, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Limperger
authors.affiliation: Thrombosis Unit, National Hemophilia Center, Tel Hashomer and the Sackler Medical School, Tel Aviv University, Israel.
authors.forename: Gili
authors.initials: G
authors.lastname: Kenet
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Kiel, Germany.
authors.forename: Ulrich C
authors.initials: UC
authors.lastname: Klostermeier
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Lübeck, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Shneyder
authors.affiliation: Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Germany.
authors.forename: Frauke
authors.initials: F
authors.lastname: Degenhardt
authors.affiliation: Medizinisches Versorgungszentrum Eberhard & Partner, Dortmund, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Finckh
authors.affiliation: Department of Pediatric Hemostaseology, University Hospital, Frankfurt, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Heller
authors.affiliation: Department of Pediatric Hematology/Oncology, Charité, Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Holzhauer
authors.affiliation: Department of Hematology/Oncology, DIAKO Bremen, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Trappe
authors.affiliation: Department of Pediatric Hematology/Oncology, University of Jena, Germany.
authors.forename: Karim
authors.initials: K
authors.lastname: Kentouche
authors.affiliation: Department of Pediatric Hemostaseology, University Hospital, Dresden, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Knoefler
authors.affiliation: Department of Pediatrics, Univ. Children Hospital Munich, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Kurnik
authors.affiliation: Department of Pediatric Hematology/Oncology, Univ. Children Hospital Münster, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Krümpel
authors.affiliation: Department of Pediatric Hematology/Oncology, Univ. Children Hospital Lübeck, Germany.
authors.forename: Melchior
authors.initials: M
authors.lastname: Lauten
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Lübeck, Germany; Department of Pediatric Hematology/Oncology, Univ. Children Hospital Münster, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Manner
authors.affiliation: Department of Medicine/Hematology & Oncology, Univ. Hospital Münster, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Mesters
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Kiel, Germany; Institute of Clinical Chemistry, Univ. Hospital Lübeck, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Junker
authors.affiliation: Institute of Clinical Chemistry, Univ. Hospital Kiel, Germany; Institute of Clinical Chemistry, Univ. Hospital Lübeck, Germany; Department of Pediatric Hematology/Oncology, Univ. Children Hospital Münster, Germany. Electronic address: leagottl@uksh.de.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nowak-Göttl
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D020151:Protein C Deficiency; D018455:Protein S Deficiency; D012008:Recurrence; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications*; D054556:Venous Thromboembolism / Q000209:etiology / Q000473:pathology*; D055815:Young Adult