Characteristics of Upper and Lower Extremity Deep Vein Thrombosis and Predictors of Post-Thrombotic Syndrome in Children

Abstract

Background/aims: Our understanding of predictors of post-thrombotic syndrome (PTS) in children is evolving. The present study aimed to investigate differences in patient- and DVT-related characteristics between central venous catheter (CVC) and non-CVC-related thrombosis in children and to study early PTS predictors. Methods: Children aged 0-18 years were recruited ≥6 months after imaging-proven upper (UE) or lower extremity (LE) DVT. PTS was measured using CAPTSure©. Early predictors included age at DVT diagnosis, symptoms, DVT burden, and days on therapeutic anticoagulation within 30 days post-DVT. Analysis of predictors was stratified in CVC and non-CVC-related thrombosis. Generalized estimating equations were used for data analyses. Results: In total, 313 DVT-affected extremities of 256 patients were assessed; 275 (88%) DVT were CVC-related. Patients with non-CVC-related thrombosis were older (median 5.8 years, 25th-75th percentile 4.9-6.4 vs. 3.5 months, 25th-75th percentile 0.7-18.7, p<0.001), and had positive thrombophilia (64% vs 22%, p<0.001) and obesity (30% vs. 13%, p=0.01) more frequently than patients with CVC-related thrombosis. PTS CAPTSure© scores were 9.5 points higher (standard error 3.0, p=0.02) in the non-CVC-related thrombosis stratum. Age at the time of DVT predicted PTS in both strata; DVT burden and time from DVT diagnosis to PTS assessment predicted PTS in CVC-related thrombosis. Conclusions: PTS severity was higher in non-CVC-related than in CVC-related thrombosis. Increasing age at the time of DVT is associated with higher PTS severity. DVT burden and time from DVT diagnosis to PTS assessment are significant PTS predictors in CVC-related thrombosis, indicating that long-term follow up of these children is important.