TY - JOUR
T1 - Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis
T2 - a multicentre cohort study
AU - Kenet, Gili
AU - Kirkham, Fenella
AU - Niederstadt, Thomas
AU - Heinecke, Achim
AU - Saunders, Dawn
AU - Stoll, Monika
AU - Brenner, Benjamin
AU - Bidlingmaier, Christoph
AU - Heller, Christine
AU - Knöfler, Ralf
AU - Schobess, Rosemarie
AU - Zieger, Barbara
AU - Sébire, Guillaume
AU - Nowak-Göttl, Ulrike
N1 - Funding Information:
We thank Anne Krümpel and Gabriele Braun-Munzinger for help in editing this manuscript. The German cohort study was supported by grants from the Karl Bröcker Stiftung and Stiftung Deutsche Schlaganfall Hilfe. The UK work received R&D funding from the National Health Service Executive. FJK was funded by the Wellcome Trust (0353521 B/92/2).
PY - 2007/7
Y1 - 2007/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=34250336361&partnerID=8YFLogxK
U2 - 10.1016/S1474-4422(07)70131-X
DO - 10.1016/S1474-4422(07)70131-X
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C2 - 17560171
AN - SCOPUS:34250336361
SN - 1474-4422
VL - 6
SP - 595
EP - 603
JO - The Lancet Neurology
JF - The Lancet Neurology
IS - 7
ER -