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Blood, 1 July 2007, Vol. 110, No. 1, pp. 45-53.
Prepublished online as a Blood First Edition Paper on March 14, 2007; DOI 10.1182/blood-2006-12-061234.
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Submitted December 4, 2006
Accepted February 26, 2007
A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of post-thrombotic syndrome in children
Neil A. Goldenberg, Janette D. Durham, R. Knapp-Clevenger, and Marilyn J. Manco-Johnson*
Mountain States Regional Hemophilia & Thrombosis Center, Aurora, CO, United States
Division of Interventional Radiology, University of Colorado at Denver and Health Sciences Center, Denver, CO, United States
Pediatric Clinical Translational Research Center, University of Colorado at Denver and Health Sciences Center, Denver, CO
Sec of Hematology/Oncology/Bone Marrow Transplantation, & Center for Cancer & Blood Disorders, University of Colorado at Denver and Health Sciences Center, Denver, CO, United States
* Corresponding author; email: marilyn.manco-johnson{at}uchsc.edu.
Important predictors of adverse outcomes of thrombosis in children, including the post-thrombotic syndrome (PTS), have recently been identified. Given this knowledge and the encouraging preliminary pediatric experience with systemic thrombolysis, we sought to retrospectively analyze our institutional experience with a thrombolytic regimen versus standard anticoagulation for acute, occlusive deep venous thrombosis (DVT) of the proximal lower extremities in children in whom plasma factor VIII activity and/or D-dimer concentration were elevated at diagnosis, from within a longitudinal pediatric cohort. Nine children who underwent the thrombolytic regimen and 13 who received standard anticoagulation alone were followed from time of diagnosis with serial clinical evaluation and standardized PTS outcome assessments conducted in uniform fashion. The thrombolytic regimen was associated with a markedly decreased odds of PTS at 18-24 months when compared to standard anticoagulation alone, which persisted after adjustment for significant covariates of age and lag time to therapy (OR=0.018, 95% CI=<0.001-0.483; P=0.02). Major bleeding developed in one child, judged clinically as not directly related to thrombolysis for DVT. These findings suggest that the use of a thrombolysis regimen may safely and substantially reduce the risk of PTS in children with occlusive lower-extremity acute DVT, providing the basis for a future clinical trial.
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