Download PDF
Thromb Haemost 2017; 117(11): 2156-2162
DOI: 10.1160/TH17-02-0109
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH Stuttgart

Increasing Incidence and Recurrence Rate of Venous Thromboembolism in Paediatric Oncology Patients in One Single Centre Over 25 Years

Authors

  • Irene L. M. Klaassen

  • Anne L. van Els

  • Marianne D. van de Wetering

  • C. Heleen van Ommen

Further Information

Publication History

15 February 2017

21 July 2017

Publication Date:
30 November 2017 (online)

   Permissions and Reprints
Preview

Abstract

Venous thromboembolism (VTE) is a serious complication in paediatric oncology patients. To identify the incidence, risk factors and recurrence rate of VTE in paediatric oncology patients, an observational, retrospective cohort study of all consecutive children (≤18 years) with malignancies, treated at the Emma Children's Hospital Academic Medical Centre between January 1989 and December 2013, was done. A matched case–control study in children with lymphomas was performed, to identify thrombotic risk factors. Cumulative recurrence-free survival after first VTE was estimated by the Kaplan–Meier method. Of the 2,183 children included (male: female = 1.4:1.0; median age, 6.6 years) with cancer, 78 patients developed VTE (3.6%; 95% confidence interval [CI], 2.8–4.4). The incidence increased from 0.8% (4/478, 95% CI, 0.0–1.6) between 1989 and 1993 to 10.4% (44/423, 95% CI, 7.6–13.4) between 2009 and 2013. Independent risk factors for VTE were age ≥ 12 years, acute lymphoblastic leukaemia (ALL) and lymphoma. The case–control study in lymphoma patients showed a trend for increased VTE incidence in stage IV lymphoma. Twelve (15.4%) patients developed recurrent thrombosis, 7 patients while on therapeutic or prophylactic anticoagulation. The cumulative recurrence-free survival after first VTE was 88.5, 87.1 and 80.6% after 1, 5 and 10 years, respectively. In conclusion, we demonstrated an increasing incidence of VTE in children with malignancies, with age ≥ 12 years, ALL and lymphoma as independent risk factors. The elevated recurrence rate underlines the importance of full anticoagulant therapy and might warrant prophylactic anticoagulation after first VTE during cancer treatment.

Keywords

venous thromboembolic disease - malignancy - paediatric - incidence - recurrence