Department of Pediatrics, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States.
Thromb Haemost. 2020 May;120(5):823-831. doi: 10.1055/s-0040-1708879. Epub 2020 May 5.
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 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.
在诱发型静脉血栓栓塞症（VTE）后，静脉血栓栓塞症（VTE）复发的预后因素在很大程度上尚不清楚。利用血栓形成和纤溶（CloFAL）测定法，单机构研究表明，在儿科 VTE 后前 3 个月内，急性高凝状态总体上得到改善，但在亚组患者中血浆凝固性增加。我们试图确定在诱发型 VTE 后前 3 个月内凝血能力升高的发生率，研究其与 D-二聚体升高的关系，并检验以下假设，即凝血能力的显著升高与 VTE 复发独立相关。在约翰霍普金斯儿科 VTE 队列和美国国立卫生研究院赞助的 Kids-DOTT 试验中，在 VTE 后 4 至 6 周和 3 个月时，对血浆进行 CloFAL 和 D-二聚体测定。通过逻辑回归评估 VTE 复发与 D-二聚体和 CloFAL 测定指标的关系。共纳入 87 例患者。中位随访时间为 1 年。6 周时，12%的患者完全静脉闭塞。在 VTE 后前 3 个月，CloFAL 测定法显示 17%的患者凝血能力显著升高，而 D-二聚体升高的患者占 21%。10%的患者发生复发性 VTE。CloFAL 测定法，但不是 D-二聚体，与复发相关（比值比 [OR] 5.87，95%置信区间 [95%CI]，1.34-25.8）。在校正静脉闭塞后，CloFAL 测定法凝血能力显著升高的患者 VTE 复发的风险增加 10 倍（OR 10.33 [95%CI，1.83-58.19]）。未来的研究应致力于阐明诱发型 VTE 后血浆凝固性升高的机制，并证实其对 VTE 复发的预后价值。
