OC 65.5 - Clinical and Laboratory-Based Risk Factors for the Development of Post-Thrombotic Syndrome (PTS) in Children with Provoked Deep Venous Thrombosis (DVT): Findings from the Kids-DOTT Trial and Biobank

Tuesday, June 25, 2024

15:45 – 16:00 ICT

Room: 110 A-C

Presenting Author(s)

Marisol Betensky, MD MPH

Assistant Professor of Pediatrics
Johns Hopkins University

Co-Author(s)

MM

Maua Mosha, PhD

Data Coordinating Center for Pediatric Multicenter Studies
Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
St Petersburg, Florida, United States
AZ

Ayesha Zia

Associate Professor
Department of Pediatrics, University of Texas Southwestern Medical Center
Dallas, Texas, United States
JJ

Julie Jaffray

Assistant Professor
Rady Children's Hospital
San Diego, California, United States
SA

Sanjay P. Ahuja

Professor
UH Rainbow Babies and Children's Hospital
cleveland, Ohio, United States
Riten Kumar, MD, MSc

Department of Pediatrics
Dana Farber/Boston Children’s Cancer and Blood Disorders Center; Harvard Medical School
Boston, Massachusetts, United States
AB

Alexandra Borst

Assistant Professor
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
KH

Kristina Haley

Associate Professor
Oregon Health & Science University
Portland, Oregon, United States
CN

Charles Nakar

Clinician
Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis,IN, USA
Indianapolis, Indiana, United States
Vera Ignjatovic, PhD, MBA

Professor of Pediatrics
Johns Hopkins All Children's Institute for Clinical and Translational Research; Department of Pediatrics, School of Medicine, Johns Hopkins University, United States
St Petersburg, Florida, United States
Neil Goldenberg, MD,PhD

Departments of Pediatrics and Medicine
Johns Hopkins University School of Medicine, Baltimore, MD; Clinical and Data Coordinating Center for Pediatric Multicenter Studies, Johns Hopkins All Children’s Institute for Clinical and Translational Research, St. Petersburg, FL
Saint Petersburg, Florida, United States

Background: PTS is the most common long-term complication in children with an extremity DVT. Clinical- and laboratory-based risk factors for the development of PTS in children are not well-studied.

Aims: To investigate the association between patient characteristics, plasma coagulability and/or impaired plasma fibrinolysis during the first 3 months post-DVT diagnosis with the development of PTS in children with provoked DVT.

Methods: We analyzed banked plasma biospecimens and clinical data from patients with an extremity DVT enrolled in the Kids-DOTT multinational trial (NCT00687882). PTS was objectively evaluated at one-year post-DVT diagnosis using the Manco-Johnson Instrument. The Clot Formation and Lysis (CloFAL) assay was performed on plasma samples obtained at 6 weeks and 3 months post-DVT. Descriptive statistics were used to summarize baseline characteristics and outcomes. Prognostic factors for PTS were evaluated via univariate logistic regression, using odds ratios (OR) and 95% confidence intervals (CI). Variables with P–values < 0.1 were included in the multivariable regression model.

Results: A total of 399 patients were included, 43% of whom developed PTS. Patients with PTS were older (9.6 vs. 7.9, p=0.016), more frequently had complete veno-occlusion at 6 weeks post-DVT diagnosis (17% vs. 10%, p=0.029), and were less likely to have had catheter-associated DVT (CADVT, 59% vs. 70%, p=0.021) compared to those without PTS (Table 1). Univariate analysis identified adolescent age, complete veno-occlusion at 6 weeks post-DVT diagnosis, CADVT, and lowest tertile of CloFAL assay fibrinolytic index at 6 weeks post-DVT diagnosis as putative prognostic factors (Table 2). On multivariable analysis, reduced plasma fibrinolytic capacity (OR=2.1, 95%CI=1.2-3.8; p=0.011) remained independently prognostic of PTS.

Conclusion(s): We have identified novel prognostic factors for the development of PTS in a large multinational trial of patients < 21 years old with provoked DVT.