European Collaborative Paediatric Database on Cerebral Venous Thrombosis: Risk Factors for Recurrent Venous Thromboembolism.

Abstract Background: Risk factors for cerebral venous thrombosis (CVT) in children include local and systemic underlying conditions, drug toxicity, and hereditary prothrombotic risk factors. Their relevance to the risk of a second venous thrombosis (VT), compared with other clinical, neuroimaging and treatment variables, is unknown. Methods: 330 of 407 consecutively enrolled CVT-patients aged newborn to <18 years (median 5.3 years; male 55%) were prospectively followed for a median (range) of 33 (12–84) months. In accordance to international treatment guidelines, 259 children (78.5%) received acute antithrombotic therapy (AT) with UFH or LMWH, followed by long-term AT with LMWH or warfarin in 218 cases (66.0%). Findings: Recurrent VT was diagnosed in 19 of 330 children (5.8%) at a median (range) age of 6 (0.5–84) months following CVT, with no difference observed between the study centres (p=0.84). Multivariate Cox regression analysis revealed that the risk of recurrence was significantly higher in those with older age at first CVT onset (p=0.02), those in whom AT was not administered prior to recurrence (p=0.0003), those who did not have complete patency rates on repeat venography at 3–6 months (p=0.01), and those subjects carrying the factor II G20210A mutation (p=0.03). Interpretation: Age at CVT onset, administration of AT, poor patency rates, and the factor II G20210A variant were of relevance to recurrent VT in children with CVT. Until evidence-based data derived from randomized treatment trials are available the message of this follow-up study is to administer any AT prophylaxis on an individual patient basis in paediatric CVT cases in newly identified VT risk situations.

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Association of the protein C promoter CG haplotype and the factor II G20210A mutation is a risk factor for cerebral venous thrombosis

Blood Coagulation & Fibrinolysis ◽

10.1097/01.mbc.0000184738.27723.b2 ◽

2005 ◽

Vol 16 (7) ◽

pp. 495-500 ◽

Cited By ~ 9

Author(s):

Véronique Le Cam-Duchez ◽

Aude Bagan-Triquenot ◽

Jean-François Ménard ◽

Bruno Mihout ◽

Jeanne-Yvonne Borg

Keyword(s):

Risk Factor ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Protein C ◽

G20210a Mutation ◽

Factor Ii

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Cerebral Venous Thrombosis and the G20210A Mutation of Factor II

Stroke ◽

10.1161/01.str.31.2.543 ◽

2000 ◽

Vol 31 (2) ◽

pp. 543-548 ◽

Cited By ~ 5

Author(s):

Pieter Jan Simons ◽

Geert Vanhooren

Keyword(s):

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

G20210a Mutation ◽

Factor Ii

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Abstract TP459: Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Cerebral Venous Thrombosis

Stroke ◽

10.1161/str.51.suppl_1.tp459 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kai Liu ◽

Shen Li ◽

Bo Song ◽

Yu Xu

Keyword(s):

Multivariate Analysis ◽

Regression Analysis ◽

Venous Thrombosis ◽

Functional Outcome ◽

Cerebral Venous Thrombosis ◽

Cox Regression ◽

Poor Functional Outcome ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

The Relationship

Background: Increasing evidences suggest that neutrophil-to- lymphocyte ratio (NLR) is an independent predictor of poor prognosis in patients with cardiovascular disease. However, it is not clear about the relationship between NLR and prognosis in patients with cerebral venous thrombosis (CVT). Methods: Consecutive CVT patients from November 2011, through January 2017 were retrospectively identified. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 3-6. Multivariate analysis and Cox regression analysis were conducted to evaluate the predictive value of NLR for unfavorable prognosis. Results: A total of 223 CVT patients were included. Multivariate analysis suggested that elevated NLR value, as a continuous variable, was significantly associated with a high risk of poor outcome (adjusted odds ratio [OR]=1.106, 95% confidence intervals [CI] 1.012-1.207, P = 0.025) and mortality (adjusted OR = 1.118; 95% CI, 1.017-1.230; P = 0.021).Receiver operating curve (ROC) analysis showed that the area under the ROC curves for NLR was 0.753 and the optimal cut-off value was 4.8 (sensitivity 81.1%, specificity 62.4%).Multivariate Cox regression analysis demonstrated that NLR>4.8 increased the risk of mortality (adjusted hazard ratio[HR]=6.111, 95% CI 1.680-22.232, P =0.006) and multivariate analysis further showed that NLR>4.8 was a significant predictor of poor functional outcome (adjusted OR=3.607, 95% CI 1.307-9.957, P =0.013). Conclusions: Elevated NLR value is associated with the long-term poor functional outcome and mortality. Future well-designed studies and experiments are needed to confirm the relationship and explore the potential mechanisms. Table 1 Results of multivariate logistic regression analysis ofpredictors for poor clinical outcome in CVTpatients. WBC,white blood cell; ANC, absolute neutrophil count; ALC, absolute lymphocyte count; *The multivariate model is adjusted for age, sex, coma, intracerebral hemorrhage, and straight sinus and/or deep CVT Figure 1. Kaplan-Meier curves of patients stratified according to the NLR value. The Kaplan-Meier curves showed a significant difference between the NLR>4.8 and NLR≤4.8 categories.

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Evaluation of the Prothrombotic Risk Factors in Children with Leukemia

Blood ◽

10.1182/blood.v112.11.5355.5355 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5355-5355

Author(s):

Aysegul Unuvar ◽

Arzu Akcay ◽

Ebru T Saribeyoglu ◽

Deniz Tugcu ◽

Zeynep Karakas ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Protein C ◽

Screening Program ◽

Prothrombin G20210a ◽

Factor V ◽

Vascular Events ◽

Jugular Vein Thrombosis ◽

G20210a Mutation ◽

Prothrombotic Risk Factors

Abstract Pediatric patients with malignancy are at high risk of thromboembolic complications due to complex interactions of a variety of factors such as the malignancy, chemotherapy, central venous catheters (CVCs), infections, dehydration, and hereditary thrombophilia. In this study, deficiencies of protein C (PC), protein S (PS), and antithrombin (AT), activated protein C resistance (APCR), the factor V G1691A mutation, the prothrombin G20210A mutation, and increased factor VIII, IX, fasting homocysteine levels were assessed at the diagnosis of leukemia, retrospectively. The aim was to evaluate the role of the thrombophilic risk factors on vascular events during treatment period. Thirty children (11 F, 19 M) with leukemia (24 patients with ALL, 4 AML, one biphenotypic leukemia, one infant leukemia) were enrolled in this study. The median age of the patients was 56 months (range 7–215 months). All patients had CVCs, and thromboprophylaxis was not given to the any patients. We detected main prothrombotic risk factors at the diagnosis of leukemia as following: low PC (8/30), PS (11/30), AT activity (3/25), APCR (5/22), increased FVIII (5/22), FIX (2/22), and homocysteine levels (2/8), and FV Leiden mutation (1/24; heterozygous). The prothrombin G20210A mutation was not detected in any patient. The parents of these patients with abnormal test results were also evaluated to discriminate congenital or acquired deficiencies. In addition; PC, PS, AT levels were followed-up, and MTHFR genotype for the patients with high homocysteine levels was studied, also. In spite of, 24 of these 30 patients had at least one abnormal laboratory test result at the diagnosis of leukemia, venous thrombosis (7 with CVC-related venous thrombosis, one CVC-related jugular vein thrombosis and VOD, one vena saphena parva thrombosis) developed in 9 of 24 patients. In conclusion, leukemic children with at least one prothrombotic risk factor have high venous thrombosis risk. Further trials are needed to clarify the necessarity of screening program for thrombophilia and thromboprophylaxis in children with leukemia and CVCs, and, especially for the patients carrying hereditary prothrombotic risk factors.

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