Predictors of postthrombotic syndrome in pediatric thrombosis: A systematic review and meta-analysis of the literature

Elissa R. Engel, Anh Thy H. Nguyen, Ernest K. Amankwah, Manuela Albisetti, Leonardo R. Brandão, Neil A. Goldenberg, Marisol Betensky

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Postthrombotic 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 = 1160 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% confidence interval [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.

Original languageEnglish (US)
Pages (from-to)2601-2612
Number of pages12
JournalJournal of Thrombosis and Haemostasis
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • VTE complications
  • pediatrics
  • post-thrombotic syndrome
  • venous thromboembolism

ASJC Scopus subject areas

  • Hematology

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