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Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study

Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study
Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study

Background: The relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown. Methods: We followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5·2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%). Results: Of 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0·1-85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11·2 95% CI 3·4-37·0; p<0·0001), persistent occlusion on repeat venous imaging (4·1, 1·1-14·8; p=0·032), and heterozygosity for the G20210A mutation in factor II (4·3, 1·1-16·2; p=0·034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset. Conclusion: Age at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research.

1474-4422
595-603
Kenet, Gili
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Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Niederstadt, Thomas
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Heinecke, Achim
a93d4bd9-42c0-4b4a-a307-1c9b4de347d1
Saunders, Dawn
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Stoll, Monika
32bba441-a39c-4bfa-928c-14012ae95aaf
Brenner, Benjamin
1b1f3033-ae33-4f86-ac75-9019fa44e607
Bidlingmaier, Christoph
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Heller, Christine
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Knöfler, Ralf
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Schobess, Rosemarie
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Zieger, Barbara
dc5d91bc-8563-4e04-854f-daf86d4f3934
Sébire, Guillaume
d9f9c5fe-6397-45a8-bc81-ac03b64318d6
Nowak-Göttl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff
Kenet, Gili
f3eb07f4-717a-432a-8cd6-570eed147e64
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Niederstadt, Thomas
626a5c09-1020-40b8-a4fa-8ba43a10c29b
Heinecke, Achim
a93d4bd9-42c0-4b4a-a307-1c9b4de347d1
Saunders, Dawn
21dab713-1e6a-486f-8bfa-eea35b382b02
Stoll, Monika
32bba441-a39c-4bfa-928c-14012ae95aaf
Brenner, Benjamin
1b1f3033-ae33-4f86-ac75-9019fa44e607
Bidlingmaier, Christoph
33058215-7b35-42ba-962d-e2b74f4b5c9b
Heller, Christine
76357108-7f01-4728-9e5e-60d19bbe3f4f
Knöfler, Ralf
0cd2e0d7-0350-4117-8d52-4d20d1d2bb25
Schobess, Rosemarie
fcb02b52-d3a0-4058-b3ef-241295e4c224
Zieger, Barbara
dc5d91bc-8563-4e04-854f-daf86d4f3934
Sébire, Guillaume
d9f9c5fe-6397-45a8-bc81-ac03b64318d6
Nowak-Göttl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff

Kenet, Gili, Kirkham, Fenella, Niederstadt, Thomas, Heinecke, Achim, Saunders, Dawn, Stoll, Monika, Brenner, Benjamin, Bidlingmaier, Christoph, Heller, Christine, Knöfler, Ralf, Schobess, Rosemarie, Zieger, Barbara, Sébire, Guillaume and Nowak-Göttl, Ulrike (2007) Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurology, 6 (7), 595-603. (doi:10.1016/S1474-4422(07)70131-X).

Record type: Article

Abstract

Background: The relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown. Methods: We followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5·2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%). Results: Of 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0·1-85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11·2 95% CI 3·4-37·0; p<0·0001), persistent occlusion on repeat venous imaging (4·1, 1·1-14·8; p=0·032), and heterozygosity for the G20210A mutation in factor II (4·3, 1·1-16·2; p=0·034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset. Conclusion: Age at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research.

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Published date: July 2007

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Local EPrints ID: 429370
URI: http://eprints.soton.ac.uk/id/eprint/429370
ISSN: 1474-4422
PURE UUID: d133031f-b888-4bbb-a7aa-2e2a7d3f5123
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 26 Mar 2019 17:30
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Gili Kenet
Author: Fenella Kirkham ORCID iD
Author: Thomas Niederstadt
Author: Achim Heinecke
Author: Dawn Saunders
Author: Monika Stoll
Author: Benjamin Brenner
Author: Christoph Bidlingmaier
Author: Christine Heller
Author: Ralf Knöfler
Author: Rosemarie Schobess
Author: Barbara Zieger
Author: Guillaume Sébire
Author: Ulrike Nowak-Göttl

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