Abstract
Conclusion: There are prothrombotic risk factors present in almost all children and adolescents with venous thrombosis. Summary: Venous thrombosis has an incidence of approximately 10/10,000 in adults and 0.07/10,000 children. (Haematologica 1999;84:59-70 and Journal Pediatr Hematol Oncol 1997;19:7-22). Little information, however, exists regarding prothrombotic risk factors in children with venous thromboembolism (VTE). The authors attempted to identify prothrombotic risk factors in adolescents and children following their first VTE event. There were 128 consecutive adolescents and children (newborn to 20 years) who were evaluated following referral to a regional coagulation center in southern Sweden. The prothrombotic risk factors evaluated included protein C, protein S, antithrombin; resistant to activated protein C; genotypes FV – G1691A, II-G20210A, MTHFR-C677T, MTHFR-A1298C, and coagulation factors VIII and XI. There was also a retrospective collection of clinical data. Identifiable genetic factors related to VTE were present in 53 of 83 (64%) subjects who had follow up blood sampling. Of these 17/83 (20%) had two or more inherited risk factors. There was a combination of acquired risk factors and genetic risk factors in 45/83 subjects (54%). At least 1 risk factor was present in 77/83 subjects (93%). There was a peak frequency of VTE in children less than 1 year of age with a second peak occurring during adolescents. Levels of coagulation factors VIII and XI were age appropriate and showed a normal Gaussian distribution. Comment: While venous thromboembolism is unusual in children and adolescents, the data here suggest that a VTE event in a child should be investigated with a detailed hypercoagulable panel. The yield is high enough to merit routine use in children with VTE.
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