OC 65.3 - Prognostic factors for complete and partial veno-occlusion following an initial six weeks of anticoagulant therapy for first-episode provoked venous thromboembolism (VTE) in patients < 21 years

Tuesday, June 25, 2024

15:15 – 15:30 ICT

Room: 110 A-C

Presenting Author(s)

Rukhmi Bhat, MD,MS

Department of Pediatrics
Northwestern University Feinberg School of Medicine, Chicago, IL; Ann & Robert H. Lurie Children’s Hospital of Chicago
Chicago, Illinois, United States

Co-Author(s)

SD

Smita Dandekar, MD

Department of Pediatrics
Penn State University, Milton S. Hershey Medical Center, Hershey, PA
Hershey, Pennsylvania, 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
AS

Anjali Sharathkumar, MD,MS

Stead Family Department of Pediatrics
University of Iowa Carver School of Medicine, Iowa City, IA
Iowa city, Iowa, United States
Fernando F. Corrales-Medina, MD

Department of Pediatrics, Division of Pediatric Hematology-Oncology
University of Miami-Miller School of Medicine, and University of Miami-Hemophilia Treatment Center
Miami, Florida, United States
Mihir Bhatt, MD, MSc

Department of Pediatrics
McMaster Children’s Hospital, McMaster University, Hamilton, Canada
Hamilton, Ontario, Canada
Heleen Van Ommen, MD, PhD

Department of Pediatric Hematology
Erasmus University Medical Center, Sophia Children's Hospital Erasmus MC, Rotterdam, The Netherlands
Rotterdam, Zuid-Holland, Netherlands
AT

Alexander GG Turpie, MD

Department of Medicine and Thromboembolism Unit
McMaster University, Hamilton, Ontario, Canada
Hamilton, Ontario, Canada
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
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: The Kids-DOTT, a multinational parallel-cohort RCT demonstrated non-inferiority of a 6-week duration of anticoagulation when compared to 3-months in young patients with a first provoked VTE in whom thrombus imaging at 6 weeks does not show complete veno-occlusion (Goldenberg et al, JAMA 2022). Prognostic factors for complete or partial veno-occlusion after a 6-week duration of anticoagulation in patients < 21 years with a first provoked acute VTE remain unknown.

Aims: To determine the frequency and prognostic factors for complete and partial veno-occlusion following 6-weeks of anticoagulation in young patients with a first provoked VTE.

Methods: Per the trial protocol, degree of veno-occlusion was assessed using the same imaging modality used to confirm the index VTE. Univariate and multivariable logistic regression analyses were performed for complete veno-occlusion and thrombus non-resolution. Variables with a p-value < 0.1 in univariate analyses were included in a multivariable model. Statistical significance was denoted by a p-value of < 0.05.

Results: Among 532 patients enrolled in the Kids-DOTT trial, 12.6% and 28.8% had complete veno-occlusion and thrombus non-resolution respectively at 6 weeks. Table 1 provides demographic and clinical characteristics of the overall study populations. Univariate analyses (Table 2) identified underlying cardiac disease and number of days to achieve therapeutic anticoagulation as putative prognostic factors for complete veno-occlusion while infection and interval days from index VTE to start of anticoagulation were identified as putative prognostic factors for thrombus non-resolution. After adjustment in a multivariable model, no statistically significant prognostic factors were identified for complete non-occlusion, while infection remained a significant prognostic factor for thrombus non-resolution (OR 1.87, 95% CI=1.20-2.91; p= 0.006).

Conclusion(s): Infection appears to be a significant prognostic factor for thrombus non-resolution, whereas prognostic factors for complete veno-occlusion remain undefined. The clinical significance of these findings in relation to VTE recurrence and post-thrombotic syndrome development are being evaluated.