TY - JOUR
T1 - In Children with Provoked Venous Thromboembolism, Increasing Plasma Coagulability during the First 3 Months Postdiagnosis is Prognostic of Recurrence
AU - Betensky, Marisol
AU - Mueller, M. Gail
AU - Amankwah, Ernest K.
AU - Goldenberg, Neil A.
N1 - Funding Information:
The Kids-DOTT trial is supported by two U01 grants (Clinical Coordinating Center, Data Coordinating Center) from the National Institutes of Health, National Heart Lung and Blood Institute (NIH NHLBI), and previously via a American Society of Hematology Bridge Grant, an Institutional Research Grant from the Johns Hopkins All Children’s Foundation, an NIH NHLBI K23 award, and a Hemophilia and Thrombosis Research Society Thrombosis Studies Award. The Johns Hopkins institutional prospective inception cohort of pediatric VTE receives support from the Johns Hopkins All Children’s Foundation.
Funding Information:
This study was funded by the following grants: All Children’s Hospital Foundation Grant; U.S. Department of Health and Human Services; National Institutes of Health’s Nation-
Publisher Copyright:
© 2020 Georg Thieme Verlag. All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Prognostic factors for venous thromboembolism (VTE) recurrence following provoked VTE are largely unknown. Using the Clot Formation and Lysis (CloFAL) assay, single institutional research has shown overall improvement in acute hypercoagulability during the first 3 months postpediatric VTE, yet a rise in plasma coagulability in a subgroup of patients. We sought to define the incidence of rise in coagulability during the first 3 months post-provoked VTE, to investigate its relationship with elevated D-dimer, and to test the hypothesis that a marked rise in coagulability is independently prognostic of VTE recurrence. CloFAL and D-dimer assays were performed on plasma at 4 to 6 weeks and 3 months post-VTE in the Johns Hopkins pediatric VTE cohort and National Institutes of Health-sponsored Kids-DOTT trial. Associations of VTE recurrence with D-dimer and CloFAL assay measures were evaluated via logistic regression. Eighty-seven patients were included. Median follow-up was 1 year. Complete veno-occlusion was determined in 12% at 6 weeks. During the first 3 months post-VTE, a marked rise in coagulability was observed by CloFAL assay in 17% of patients, while D-dimer was elevated in 21%. Recurrent VTE occurred in 10% of patients. CloFAL assay, but not D-dimer, was associated with recurrence (odds ratio [OR] 5.87, 95% confidence interval [95% CI], 1.34-25.8]). After adjustment for veno-occlusion, patients with a marked rise in coagulability by CloFAL assay had a 10-fold increased risk of recurrent VTE (OR 10.33 [95% CI, 1.83-58.19]). Future work should seek to elucidate the mechanisms underlying a rise in plasma coagulability following provoked VTE and to substantiate its prognostic utility for recurrent VTE.
AB - Prognostic factors for venous thromboembolism (VTE) recurrence following provoked VTE are largely unknown. Using the Clot Formation and Lysis (CloFAL) assay, single institutional research has shown overall improvement in acute hypercoagulability during the first 3 months postpediatric VTE, yet a rise in plasma coagulability in a subgroup of patients. We sought to define the incidence of rise in coagulability during the first 3 months post-provoked VTE, to investigate its relationship with elevated D-dimer, and to test the hypothesis that a marked rise in coagulability is independently prognostic of VTE recurrence. CloFAL and D-dimer assays were performed on plasma at 4 to 6 weeks and 3 months post-VTE in the Johns Hopkins pediatric VTE cohort and National Institutes of Health-sponsored Kids-DOTT trial. Associations of VTE recurrence with D-dimer and CloFAL assay measures were evaluated via logistic regression. Eighty-seven patients were included. Median follow-up was 1 year. Complete veno-occlusion was determined in 12% at 6 weeks. During the first 3 months post-VTE, a marked rise in coagulability was observed by CloFAL assay in 17% of patients, while D-dimer was elevated in 21%. Recurrent VTE occurred in 10% of patients. CloFAL assay, but not D-dimer, was associated with recurrence (odds ratio [OR] 5.87, 95% confidence interval [95% CI], 1.34-25.8]). After adjustment for veno-occlusion, patients with a marked rise in coagulability by CloFAL assay had a 10-fold increased risk of recurrent VTE (OR 10.33 [95% CI, 1.83-58.19]). Future work should seek to elucidate the mechanisms underlying a rise in plasma coagulability following provoked VTE and to substantiate its prognostic utility for recurrent VTE.
KW - pediatrics
KW - thrombophilia
KW - thrombosis
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85084276954&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084276954&partnerID=8YFLogxK
U2 - 10.1055/s-0040-1708879
DO - 10.1055/s-0040-1708879
M3 - Article
C2 - 32369853
AN - SCOPUS:85084276954
SN - 0340-6245
VL - 120
SP - 823
EP - 831
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 5
ER -