Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study

Abstract

SummaryBackgroundThe relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown.MethodsWe followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5·2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%).ResultsOf 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0·1–85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11·2 95% CI 3·4–37·0; p<0·0001), persistent occlusion on repeat venous imaging (4·1, 1·1–14·8; p=0·032), and heterozygosity for the G20210A mutation in factor II (4·3, 1·1–16·2; p=0·034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset.ConclusionAge at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research.

Aspects of anticoagulation in children

“…It is notable that children with CVLs and cancer were excluded from the study reported by Nowak-Gottl et al (2001). In a multicentre study of children with cerebral sinovenous thrombosis (SVT) the presence of the F2 (prothrombin gene) G20210A mutation was found to be associated with an increased risk of recurrence (hazard ratio 4AE3, 95% CI 1AE1-16AE2; P = 0AE034) but F5 R506Q (factor V Leiden; FVL) was not predictive of recurrence (Kenet et al, 2007). A recent systematic review showed that recurrent VTE in children is significantly associated with deficiencies of protein C, protein S and antithrombin, the F2 variant and combined genetic traits (Young et al, 2008).…”

Cerebral Vein Thrombosis Post Cabg Precipitated by Malposition of Subclavian Central Catheter in Protein C & S Deficiency Patient

“…SVT has been often a multi factorial disease, i.e the identification of a risk factor or even of a cause should not deter a search for other causes (5,6). Several studies, have described some of the well-established risk factors for SVT that include inherited thrombophilia such as factor V Leiden mutation, protein C and S deficiency, acquired prothrombotic state (pregnancy, purperium and postsurgical period), hepatic dysfunction ,autoimmune disease (Behçet syndrome, systemic lupus erythematosus), malignancy (lung cancer, blood dyscrasia, systemic carcinoma), systemic infectious disease, local infection of the skull (e. (7)(8)(9)(10)(11)(12)(13)(14). Nagesh Kumar reported a case of a 35 years old male who presented to the emergency center with drowsiness and focal seizures leading to grand seizures and loss of consciousness.…”

Venous sinus thrombosis leading to stroke in a patient with sickle cell disease on hydroxyurea and high hemoglobin levels: Treatment with thrombolysis

“…Heparin arrests the thrombotic process and may prevent the development of infarcts. Despite the risk of hemorrhagic complications, anticoagulation is associated with a potentially important reduction in the risks of death and neurologic morbidity in adults, and of recurrence in children [19,20]. The other treatment option in patients with DSVT is thrombolysis.…”