Lenahan Stephanie F, Blackmore Anne, Fenchel Matthew, Thomas Evan, Palumbo Joseph S, Tarango Cristina
Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Blood Adv. 2025 Aug 12;9(15):3824-3831. doi: 10.1182/bloodadvances.2025016135.
Risk factors for recurrent venous thromboembolism (VTE) in children are poorly understood, and concerns remain about the risks of anticoagulant therapy in children. This single-center cohort with nested case-control study aimed to determine the incidence rate of recurrent thrombosis and associated risk factors and the incidence of major bleeding in children with VTE on therapeutic anticoagulation. We identified 632 patients managed for VTE between 1 January 2015 and 31 December 2022. The recurrence rate of VTE was 13.7 per 100 person-years. Univariate analysis showed the presence of a central venous catheter (CVC; P = .02), inflammatory bowel disease (IBD; P = .02), and intestinal failure (P = .03) were significant risk factors for recurrent VTE. In multivariate logistic regression, significant risk factors for recurrence were anatomic venous abnormality (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.37-5.59), presence of a CVC (OR, 2.0; 95% CI, 1.21-3.26), and IBD (OR, 3; 95% CI, 1.18-7.98). Major bleeding on anticoagulation occurred at a rate of 2.2 per 100 person-years. These data demonstrate that this heterogeneous cohort of children had a high risk of VTE recurrence. The overall major bleeding risk with anticoagulation was low. Although each patient with VTE needs to be considered individually, these data support the view that perceived bleeding risk should generally not be a major barrier to anticoagulation in the pediatric setting. Moreover, secondary or extended anticoagulation may be considered in children at high risk for recurrence.
儿童复发性静脉血栓栓塞（VTE）的危险因素尚不清楚，人们对抗凝治疗在儿童中的风险仍存在担忧。这项单中心队列嵌套病例对照研究旨在确定复发性血栓形成的发生率、相关危险因素以及接受治疗性抗凝的VTE儿童发生大出血的发生率。我们确定了2015年1月1日至2022年12月31日期间接受VTE治疗的632例患者。VTE的复发率为每100人年13.7例。单因素分析显示，中心静脉导管（CVC；P = .02）、炎症性肠病（IBD；P = .02）和肠衰竭（P = .03）的存在是复发性VTE的重要危险因素。在多因素逻辑回归中，复发的重要危险因素是解剖学静脉异常（比值比[OR]，2.8；95%置信区间[CI]，1.37 - 5.59）、CVC的存在（OR，2.0；95% CI，1.21 - 3.26）和IBD（OR，3；95% CI，1.18 - 7.98）。抗凝治疗期间大出血的发生率为每100人年2.2例。这些数据表明，这群异质性儿童有较高的VTE复发风险。抗凝治疗导致的总体大出血风险较低。虽然每个VTE患者都需要单独考虑，但这些数据支持这样一种观点，即在儿科环境中，感知到的出血风险通常不应成为抗凝治疗的主要障碍。此外，对于复发风险高的儿童，可以考虑进行二级或延长抗凝治疗。
