Risk factors and co-morbidities in adolescent thromboembolism are different than those in younger children

• Published in: Thrombosis research 2016-05, Vol.141, p.178-182
• Main Authors: Ishola, Titilope, Kirk, Susan E, Guffey, Danielle, Voigt, Katherine, Shah, Mona D, Srivaths, Lakshmi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Anticoagulants - therapeutic use; Child; Comorbidity; Deep vein thrombosis; Female; Hematology, Oncology and Palliative Medicine; Humans; Kaplan-Meier Estimate; Male; Pediatrics; Retrospective Studies; Risk Factors; Thromboembolism; Thromboembolism - diagnosis; Thromboembolism - drug therapy; Thromboembolism - epidemiology; Young Adult
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2016.03.021

Abstract Introduction In adolescent thromboembolism (TE), multiple risk factors (RFs) and co-morbidities (CMs) are reported, though overall prevalence has not been evaluated. We hypothesized that the spectrum of RFs/CMs in adolescent TE differs from children overall and sought to review Texas Children's Hospital's experience. Patients/methods Medical records of adolescents aged 12–21 years, diagnosed with arterial or venous TE (AT/DVT) from 2004 to 2014, were retrospectively reviewed and analyzed with IRB approval. Results Sixty-four adolescents (median age 16, range 12–20 years) met study criteria. Fifty-seven (89%) had DVT and six (9%) had AT. Associated RFs/CMs included obesity (47%), CVC (27%), infection (27%), surgery (27%), autoimmune disease (20%), immobility (22%), anatomical abnormality (20%), cancer (8%), estrogen therapy (6%), tobacco use (6%), trauma (3%), inherited thrombophilia (19%), and other medical conditions (11%). Fifty-two (81%) had ≥ 2 RFs/CMs. Therapy included anticoagulants, antiplatelet agents, and interventional therapy. Of those with follow-up imaging, 49 had complete or partial resolution, 5 had no change and 4 had progression. Fourteen (22%) had recurrent TE. The majority with recurrent TE (79%) had ≥ 2 RFs at initial diagnosis. Mean time to recurrence was 4.80 years; time to recurrence was shorter for occlusive TE (p = 0.026). Conclusion Adolescent TE is often multi-factorial with the majority having ≥ 2 RFs at diagnosis, suggesting the need for detailed evaluation for RFs in this population, which may enable optimal management including thromboprophylaxis, and institution of RF-modifying strategies to prevent occurrence/recurrence.