Abstract
Prognostic factors for residual thrombosis (RT) and complete veno-occlusion (CVO) after 6 weeks of anticoagulation in pediatric acute VTE remain unknown. This study assessed the frequency and predictors of RT and CVO through a pre-specified secondary analysis of the Kids-DOTT randomized clinical trial.
Per trial protocol, RT and CVO were radiologically assessed six weeks after acute VTE diagnosis. Univariate logistic regression analyses were performed for both outcomes, and variables with p-value 0.05 were included in a multivariable models, where a p-value of <0.05 denoted statistical significance.
Among 532 enrolled patients, 28.8% demonstrated RT and 12.6% CVO after six weeks of treatment. Age and sex distributions did not differ significantly by RT and CVO status. In multivariable analysis, cerebral venous sinus location of VTE (OR 2.52, 95% CI=1.22-5.21; p=0.01) and comorbid infection (OR 1.61, 95% CI=1.00-2.58; p=0.049) were independently associated with RT. Internal jugular vein (OR 3.97, 95% CI=1.26-12.48; p=0.02) and lower extremity VTE (OR 2.28, 95% CI=1.01-5.15; p= 0.046) were independently associated with CVO.
Approximately 29% of young patients developed RT, and 13% CVO, after six weeks of anticoagulation. VTE location and comorbid infection were identified as predictors for RT and CVO. These findings highlight the need for further studies on long-term outcomes of RT and CVO, particularly their impact on post thrombotic syndrome development and quality of life measures in pediatric VTE.