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Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: A Systematic Review and Meta-Analysis of the Literature.
J Thromb Haemost. 2020 Jul 02 [Online ahead of print]JT

Abstract

BACKGROUND

Post-thrombotic syndrome (PTS) is a significant complication of pediatric deep venous thrombosis (DVT). There is a gap in the understanding of the risk factors associated with the development of pediatric PTS preventing the early identification of those patients at greatest risk, and the development of risk-stratified interventions.

OBJECTIVES

To conduct a systematic review and meta-analysis of the literature on prognostic factors for PTS development in pediatric patients.

METHODS

A systematic search of MEDLINE, EMBASE, and the Cochrane Library from 1960 to December 2018 was performed. Eligible studies reported at least one prognostic factor for PTS development in patients <21 years of age with a radiographically confirmed DVT. To be included in the meta-analysis, prognostic factors had to be reported in at least three published studies.

RESULTS AND CONCLUSIONS

Twelve studies (n= 1,160 patients) met criteria for inclusion. Ninety-three percent of patients with an extremity DVT(n=1076) were assessed for PTS. PTS developed in 40% (n=434) of these patients. Central venous catheter-associated DVT (odds ratio [OR] 1.8, 95% CI 1.08-2.98), complete veno-occlusion (OR 1.89, 95% CI 1.04-3.46), and incomplete DVT resolution (OR 2.07, 95% CI 1.4-3.07) were identified as candidate prognostic factors for pediatric PTS. These findings should be interpreted in the context of the heterogeneity of the included studies and the limitations of current pediatric PTS assessment tools. Further, the predictive value of these prognostic factors will need to be validated in future collaborative prospective multicenter studies that maximize the homogeneity of pediatric DVT patients.

Authors+Show Affiliations

Department of Pediatrics, University of South Florida, Tampa, FL, USA.Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA.Epidemiology and Biostatistics Unit, Johns Hopkins All Children's Health Informatics, St. Petersburg, FL, USA. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA. Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.Hematology Department, University Children's Hospital, Zürich, Switzerland.Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA. Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA. Johns Hopkins All Children's Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32614496

Citation

Engel, Elissa R., et al. "Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: a Systematic Review and Meta-Analysis of the Literature." Journal of Thrombosis and Haemostasis : JTH, 2020.
Engel ER, Nguyen ATH, Amankwah EK, et al. Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: A Systematic Review and Meta-Analysis of the Literature. J Thromb Haemost. 2020.
Engel, E. R., Nguyen, A. T. H., Amankwah, E. K., Albisetti, M., Brandão, L. R., Goldenberg, N. A., & Betensky, M. (2020). Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: A Systematic Review and Meta-Analysis of the Literature. Journal of Thrombosis and Haemostasis : JTH. https://doi.org/10.1111/jth.14984
Engel ER, et al. Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: a Systematic Review and Meta-Analysis of the Literature. J Thromb Haemost. 2020 Jul 2; PubMed PMID: 32614496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of Post-Thrombotic Syndrome in Pediatric Thrombosis: A Systematic Review and Meta-Analysis of the Literature. AU - Engel,Elissa R, AU - Nguyen,Anh Thy H, AU - Amankwah,Ernest K, AU - Albisetti,Manuela, AU - Brandão,Leonardo R, AU - Goldenberg,Neil A, AU - Betensky,Marisol, Y1 - 2020/07/02/ PY - 2020/7/3/entrez KW - PTS KW - Pediatrics KW - Post-thrombotic syndrome KW - VTE Complications KW - venous thromboembolism JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. N2 - BACKGROUND: Post-thrombotic syndrome (PTS) is a significant complication of pediatric deep venous thrombosis (DVT). There is a gap in the understanding of the risk factors associated with the development of pediatric PTS preventing the early identification of those patients at greatest risk, and the development of risk-stratified interventions. OBJECTIVES: To conduct a systematic review and meta-analysis of the literature on prognostic factors for PTS development in pediatric patients. METHODS: A systematic search of MEDLINE, EMBASE, and the Cochrane Library from 1960 to December 2018 was performed. Eligible studies reported at least one prognostic factor for PTS development in patients <21 years of age with a radiographically confirmed DVT. To be included in the meta-analysis, prognostic factors had to be reported in at least three published studies. RESULTS AND CONCLUSIONS: Twelve studies (n= 1,160 patients) met criteria for inclusion. Ninety-three percent of patients with an extremity DVT(n=1076) were assessed for PTS. PTS developed in 40% (n=434) of these patients. Central venous catheter-associated DVT (odds ratio [OR] 1.8, 95% CI 1.08-2.98), complete veno-occlusion (OR 1.89, 95% CI 1.04-3.46), and incomplete DVT resolution (OR 2.07, 95% CI 1.4-3.07) were identified as candidate prognostic factors for pediatric PTS. These findings should be interpreted in the context of the heterogeneity of the included studies and the limitations of current pediatric PTS assessment tools. Further, the predictive value of these prognostic factors will need to be validated in future collaborative prospective multicenter studies that maximize the homogeneity of pediatric DVT patients. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32614496/Predictors_of_Post-Thrombotic_Syndrome_in_Pediatric_Thrombosis:_A_Systematic_Review_and_Meta-Analysis_of_the_Literature L2 - https://doi.org/10.1111/jth.14984 DB - PRIME DP - Unbound Medicine ER -
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