Hope P Wilson, Maua M Alleyne, Sanjay Ahuja, Ernest Amankwah, Aisha Bruce, Shannon L Carpenter, Fernando F Corrales-Medina, Craig A Mullen, Arun Panigrahi, Lakshmi Srivaths, Courtney D Thornburg, Anupam Verma, Gary Woods, Neil A Goldenberg, Madhvi Rajpurkar
These findings suggest the need for further studies to determine optimal posttreatment follow-up in this older age group to increase PTS detection rates. We recommend that future collaborative pediatric VTE studies systematically collect social determinants of health variables to better assess their impact on VTE presentation, treatment, and outcomes in children.
BACKGROUND: Venous thromboembolism (VTE) is associated with adverse long-term sequelae, including recurrence and development of chronic venous insufficiency following limb deep vein thrombosis (postthrombotic syndrome [PTS]). Adult VTE studies have demonstrated that lower socioeconomic status, Black race, and Latinx ethnicity are associated with an increased risk of recurrence. Clinical trial-derived pediatric VTE data are limited.
OBJECTIVES: The objective of this study was to assess whether clinical features of provoked VTE and outcomes vary across sociodemographic characteristics and proxies for social determinants of health among children enrolled in the Kids-duration of therapy for thrombosis trial.
METHODS: We conducted a secondary analysis of the multinational Kids-duration of therapy for thrombosis parallel-cohort randomized controlled trial (NCT00687882). We limited our analysis to United States participants and utilized the 8 Health Resources and Services Administration-designated geographic regions to construct 4 consolidated regions. After exclusions, 409 participants were evaluable.
RESULTS: The location of VTE varied by age (P < .001), with the lower extremity as the most common location in neonates and children (63% and 47%, respectively), and the upper extremity as the most common VTE location in teenagers (48%). Teenagers had the highest rates of PTS at 2 years (62%; P = .003) compared with neonates (33%) and children (37%). We found no difference in the rate of residual thrombosis across groups.
CONCLUSION: These findings suggest the need for further studies to determine optimal posttreatment follow-up in this older age group to increase PTS detection rates. We recommend that future collaborative pediatric VTE studies systematically collect social determinants of health variables to better assess their impact on VTE presentation, treatment, and outcomes in children.