Prevalence of post‐thrombotic syndrome following asymptomatic thrombosis in survivors of acute lymphoblastic leukemia

Abstract

LG. Prevalence of post-thrombotic syndrome following asymptomatic thrombosis in survivors of acute lymphoblastic leukemia. J Thromb Haemost 2008; 6: 589-94.Summary. Background: Deep vein thrombosis (DVT) is a complication of treatment of acute lymphoblastic leukemia (ALL) in children but little is known about the long-term outcomes of these DVT. Objective: To determine the incidence of post-thrombotic syndrome (PTS) in (i) children with ALL diagnosed with asymptomatic DVT using radiographic testing and (ii) an unselected group of ALL survivors. Methods: Cross-sectional study in two populations. Group I comprised children in the Prophylactic Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) study diagnosed with DVT by radiographic tests. Group II consisted of non-selected childhood ALL survivors <21 years. PTS was assessed using a standardized scoring sheet. Results: Group I: 13 PARKAA patients (median age 12 years) were assessed, and 7 had PTS (54%; 95% CI, 25-81). All patients had collaterals, three also had increased arm circumference. Group II: 41 patients (median age 13 years) with a history of ALL were enrolled, and 10 had PTS (24%; 95% CI, 11-38). All patients had collaterals; five also had increased arm circumference. Conclusion: There is a high incidence of PTS in survivors of childhood ALL with radiographically diagnosed asymptomatic DVT. A significant proportion of ALL survivors develop PTS, indicating previously undiagnosed DVT.

Validation of a predictive model for identifying an increased risk for thromboembolism in children with acute lymphoblastic leukemia: results of a multicenter cohort study

“…11,32,33 Second, the model was developed to predict symptomatic radiographically confirmed but not asymptomatic VTE. A prospective cohort study showed, however, that survivors of childhood ALL with asymptomatic VTE during chemotherapy had postthrombotic syndrome in 50% of cases, 34 an estimated prevalence comparable to that in the general pediatric population with symptomatic VTE. Therefore, the model needs to be assessed in relation to asymptomatic VTE in future studies.…”

Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors

“…A flow chart of search results and their distribution by category of publication is provided in Figure 1, showing both included [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and excluded reports. Nineteen original reports met eligibility criteria (Table 1); no systematic reviews were identified.…”

“…In evaluating PTS, five studies 8,13,14,18,20 used a pediatric modification 8 of the Villalta scoring system for PTS in adults, 73 two studies 11,16 Reviews/commentaries (n=16) Not pediatric (n=13) Not VTE (n=8) Not followed for PTS (n=4) Single case reports (n=3) Cases selected due to PTS (n=2)…”

“…Publication Villalta instrument, 8,14,18,20 and functional significance of PTS was reported only in a single study, using the MancoJohnson instrument. 16 …”

Phase 3, single‐arm, multicenter study of dabigatran etexilate for secondary prevention of venous thromboembolism in children: Rationale and design

“…Estimates of the rate of pediatric VTE recurrence vary widely,6, 7 ranging between 2% and 21% 8. Post‐thrombotic syndrome (PTS), another long‐term consequence of VTE, has been reported in 12‐65% of children following an initial VTE 1, 7, 9, 10, 11, 12. Risk factors associated with VTE recurrence include underlying chronic conditions associated with a prothrombotic tendency, such as malignancies, cardiac/vascular abnormalities, short bowel syndrome with total parenteral nutrition dependency, or congenital disorders (eg, severe inherited thrombophilias).…”