Pediatric venous thromboembolic disease in one single center: Congenital prothrombotic disorders and the clinical outcome

To learn more about the frequencies of congenital prothrombotic disorders in pediatric venous thromboembolism (VTE) and the outcome of this disease, we evaluated consecutive patients from 0 to 18 years with objectively diagnosed VTE at a single tertiarycenter over a 12-year period. We included 100 patients, with a median age at diagnosis of 1.0 year (range 2 days to 17 years). At least one underlying clinical condition was present in 96% of the patients. Factor (F)V G1691A mutation was present in 13%, FII G20210A mutation in 3%, antithrombin deficiencyin 1%, protein C deficiencyin 1% and protein S deficiencyin 1% of the tested patients. Combined defects were present in 2.6% of the 77 patients with a complete work-up. Positive familyhistoryappeared to be the onlypredictor for positive testing for congenital disorders (OR 14.9, 95% CI 1.9-113). The overall mortalityrate was 20%. The cumulative recurrence-free survival was 92% after 1 year of follow-up, and 82% after 7 years. The incidence and severity of the post-thrombotic syndrome was analyzed in a subgroup of 33 patients with VTE of the lower extremities. Twenty-three (70%) patients developed PTS: moderate in three and mild in 20 patients. In conclusion, congenital prothrombotic disorders seem to playa role in the development of pediatric VTE, and the risk of complications of this disease is high.