Outcomes in children with provoked venous thrombosis and antiphospholipid antibodies: findings from the Kids-DOTT trial.

Autor:	Betensky M; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL.; Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL., Mosha M; Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL., Tarango C; Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital and Medical Center, Cancer and Blood Diseases Institute, Cincinnati, OH., Verma A; Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT., Bhat R; Division of Hematology/Oncology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Lurie Children's Hospital, Chicago, IL., Kucine NE; Division of Hematology/Oncology, Department of Pediatrics, Cornell University Weill School of Medicine, New York, NY., Nakano T; Division of Hematology/Oncology/Bone Marrow Transplant, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO., Nakar C; Indiana Hemophilia and Thrombosis Center, Indianapolis, IN., Woods G; Division of Hematology, Department of Pediatrics, Emory University School of Medicine and Children's Hospital of Atlanta, Atlanta, GA., Amankwah E; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL.; Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL.; Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD., Brandão LR; Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Schulman S; Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada.; Department of Obstetrics and Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia., Goldenberg NA; Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.; Johns Hopkins All Children's Cancer and Blood Disorders Institute, St. Petersburg, FL.; Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL.; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 Nov 26; Vol. 8 (22), pp. 5790-5795.
DOI:	10.1182/bloodadvances.2024014415
Abstrakt:	Abstract: Few studies have prospectively evaluated the incidence and outcomes in children with provoked venous thromboembolism (VTE) and transient or persistent antiphospholipid antibodies (aPLs). We compared outcomes of patients aged <21 years with a first-episode acute provoked VTE and positive aPL at diagnosis, enrolled in the Multicenter Evaluation of the Duration of Therapy for Thrombosis in Children trial. aPLs were tested at enrollment and, when positive, repeated at 6 weeks after VTE diagnosis. Subsequent testing was performed at the discretion of the treating hematologist. Of 524 patients, 116 (22%) had positive aPLs at enrollment. At follow-up, 70 (60%) had transient (n = 66) or low-titer aPLs (n = 4), 11 (10%) had persistent aPLs meeting the criteria for antiphospholipid antibody syndrome (APS), and 35 (30%) had no repeat testing. Patients with APS were older (15.8 vs 9.9 years; P = .014) and had a statistically significant higher risk of symptomatic recurrent VTE (18% vs 1%; odds ratio [OR], 12.2; 95% confidence interval [CI], 1.4-108; P = .025) and a statistically nonsignificant but clinically meaningful difference in the risk of anticoagulant-related clinically relevant bleeding (9% vs 0%; OR, 20.1; 95% CI, 0.7-558; P = .077) compared with those in the transient or low-titer aPL group. In conclusion, aPLs are common in young patients with acute provoked VTE and are mostly transitory and clinically insignificant. Patients with APS and provoked VTE appear to have an increased risk of recurrent VTE compared with patients with transitory or low-titer aPLs. Future collaborative studies should investigate the optimal VTE management for children with provoked VTE who meet the criteria for APS. The trial was registered at www.ClinicalTrials.gov as #NCT00687882. (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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