Athrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children

Neil Goldenberg, Janette D. Durham, R. Knapp-Clevenger, Marilyn J. Manco-Johnson

Research output: Contribution to journalArticle

Abstract

Important predictors of adverse outcomes of thrombosis in children, including postthrombotic syndrome (PTS), have recently been identified. Given this knowledge and the encouraging preliminary pediatric experience with systemic thrombolysis, we sought to retrospectively analyze our institutional experience with a thrombolytic regimen versus standard anticoagulation for acute, occlusive deep venous thrombosis (DVT) of the proximal lower extremities in children in whom plasma factor VIII activity and/or D-dimer concentration were elevated at diagnosis, from within a longitudinal pediatric cohort. Nine children who underwent the thrombolytic regimen and 13 who received standard anticoagulation alone were followed from time of diagnosis with serial clinical evaluation and standardized PTS outcome assessments conducted in uniform fashion. The thrombolytic regimen was associated with a markedly decreased odds of PTS at 18 to 24 months compared with standard anticoagulation alone, which persisted after adjustment for significant covariates of age and lag time to therapy (odds ratio [OR] = 0.018, 95% confidence interval [CI] = <0.001-0.483; P = .02). Major bleeding developed in 1 child, clinically judged as not directly related to thrombolysis for DVT. These findings suggest that the use of a thrombolysis regimen may safely and substantially reduce the risk of PTS in children with occlusive lower-extremity acute DVT, providing the basis for a future clinical trial.

Original languageEnglish (US)
Pages (from-to)45-53
Number of pages9
JournalBlood
Volume110
Issue number1
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

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Postthrombotic Syndrome
Venous Thrombosis
Pediatrics
Factor VIII
Lower Extremity
Plasmas
Thrombosis
Odds Ratio
Outcome Assessment (Health Care)
Clinical Trials
Confidence Intervals
Hemorrhage

ASJC Scopus subject areas

  • Hematology

Cite this

Athrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. / Goldenberg, Neil; Durham, Janette D.; Knapp-Clevenger, R.; Manco-Johnson, Marilyn J.

In: Blood, Vol. 110, No. 1, 01.07.2007, p. 45-53.

Research output: Contribution to journalArticle

Goldenberg, Neil ; Durham, Janette D. ; Knapp-Clevenger, R. ; Manco-Johnson, Marilyn J. / Athrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children. In: Blood. 2007 ; Vol. 110, No. 1. pp. 45-53.
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