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Recurrent thrombosis and major bleeding in children treated for VTE
Stephanie F Lenahan1, Anne Blackmore1, Matthew Fenchel2
1Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Blood Advances
|April 16, 2025
Summary
Pediatric venous thromboembolism (VTE) recurrence is high, with central venous catheters, inflammatory bowel disease, and venous abnormalities as key risk factors. Anticoagulation in children with VTE is generally safe, with a low major bleeding risk.
Area of Science:
- Pediatric Hematology
- Vascular Medicine
- Clinical Thrombosis
Background:
- Recurrent venous thromboembolism (VTE) risk factors in children are not well-defined.
- Concerns persist regarding the safety of anticoagulant therapy in pediatric patients.
- Understanding these factors is crucial for effective VTE management in children.
Purpose of the Study:
- To determine the incidence rate of recurrent VTE in children.
- To identify risk factors associated with VTE recurrence in pediatric patients.
- To assess the incidence of major bleeding in children with VTE receiving anticoagulation.
Main Methods:
- A single-center cohort study with a nested case-control design.
- Inclusion of 632 pediatric patients diagnosed with VTE between 2015 and 2022.
- Statistical analysis including univariate and multivariate logistic regression to identify risk factors and bleeding rates.
Main Results:
- The VTE recurrence rate was 13.7 per 100 person-years.
- Significant risk factors for recurrence included central venous catheter, inflammatory bowel disease, intestinal failure, and anatomic venous abnormality.
- Major bleeding occurred at a low rate of 2.2 per 100 person-years.
Conclusions:
- Pediatric patients with VTE exhibit a high risk of recurrence.
- Therapeutic anticoagulation in children with VTE is associated with a low risk of major bleeding.
- The risk of bleeding should not deter anticoagulation, and extended therapy may be considered for high-risk children.
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