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Predictors of postthrombotic syndrome in pediatric thrombosis: A systematic review and meta‐analysis of the literature
Author(s) -
Engel Elissa R.,
Nguyen Anh Thy H.,
Amankwah Ernest K.,
Albisetti Manuela,
Brandão Leonardo R.,
Goldenberg Neil A.,
Betensky Marisol
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14984
Subject(s) - medicine , meta analysis , odds ratio , confidence interval , context (archaeology) , venous thrombosis , medline , cochrane library , systematic review , thrombosis , pediatrics , paleontology , political science , law , biology
Background Postthrombotic syndrome (PTS) is a significant complication of pediatric deep venous thrombosis (DVT). There is a gap in the understanding of the risk factors associated with the development of pediatric PTS preventing the early identification of those patients at greatest risk, and the development of risk‐stratified interventions. Objectives To conduct a systematic review and meta‐analysis of the literature on prognostic factors for PTS development in pediatric patients. Methods A systematic search of MEDLINE, EMBASE, and the Cochrane Library from 1960 to December 2018 was performed. Eligible studies reported at least one prognostic factor for PTS development in patients < 21 years of age with a radiographically confirmed DVT. To be included in the meta‐analysis, prognostic factors had to be reported in at least three published studies. Results and conclusions Twelve studies (n = 1160 patients) met criteria for inclusion. Ninety‐three percent of patients with an extremity DVT (n = 1076) were assessed for PTS. PTS developed in 40% (n = 434) of these patients. Central venous catheter‐associated DVT (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.08‐2.98), complete veno‐occlusion (OR, 1.89; 95% CI, 1.04‐3.46), and incomplete DVT resolution (OR, 2.07; 95% CI, 1.4‐3.07) were identified as candidate prognostic factors for pediatric PTS. These findings should be interpreted in the context of the heterogeneity of the included studies and the limitations of current pediatric PTS assessment tools. Further, the predictive value of these prognostic factors will need to be validated in future collaborative prospective multicenter studies that maximize the homogeneity of pediatric DVT patients.