Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database.
Adolescent
Adult
Central Nervous System Neoplasms
/ complications
Child
Child, Preschool
Databases, Factual
/ statistics & numerical data
Female
Follow-Up Studies
Hospitalization
/ statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Prognosis
Retrospective Studies
Survival Rate
Venous Thromboembolism
/ etiology
Young Adult
CNS tumor
PHIS database
venous thromboembolism
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
01
10
2020
revised:
23
11
2020
accepted:
26
11
2020
pubmed:
20
12
2020
medline:
3
8
2021
entrez:
19
12
2020
Statut:
ppublish
Résumé
Central nervous system (CNS) tumors are the second most common malignancy of childhood, and published data on venous thromboembolism (VTE) rate and risk factors for these patients are outdated or incomplete. Here, we determine the cumulative incidence and risk factors for VTE in this population. VTE diagnosis and associated clinical risk factors were abstracted and analyzed for two cohorts of children (0-21 years) diagnosed with CNS tumors between January 1, 2010 to September 30, 2018. The first study was a retrospective single institution cohort study. The initial observations were confirmed across multiple pediatric hospitals using the Pediatric Health Information System (PHIS) administrative database. The single-institution cohort included 338 patients aged 3 days to 20.9 years (median age, 8.6 years); VTE developed in eight (2.4%) patients. The PHIS cohort included 17 634 patients aged from 0 to 21.9 years (median: 9.5 years); VTE developed in 354 (2.0%) patients. Univariate analysis for the single-institution cohort identified central venous catheter (CVC) placement as a risk factor for VTE (odds ratio [OR] 8.40, 95% confidence interval [CI] 1.43-49.41, P = .0186). Multivariable analysis of the PHIS dataset identified CVC placement (OR 1.97, 95% CI 1.57-2.46; P < .0001), obesity (OR 2.96, 95% CI 1.21-7.26; P = .0177), and more than one hospital admission (OR 3.54, 95% CI 2.69-4.64; P < .0001) as significant predictors of VTE. VTE diagnosis was not associated with increased mortality in either cohort. The VTE rate in children with CNS tumors is low (2%). CVC placement was identified as a modifiable risk factor in both cohorts.
Sections du résumé
BACKGROUND
Central nervous system (CNS) tumors are the second most common malignancy of childhood, and published data on venous thromboembolism (VTE) rate and risk factors for these patients are outdated or incomplete. Here, we determine the cumulative incidence and risk factors for VTE in this population.
PROCEDURE
VTE diagnosis and associated clinical risk factors were abstracted and analyzed for two cohorts of children (0-21 years) diagnosed with CNS tumors between January 1, 2010 to September 30, 2018. The first study was a retrospective single institution cohort study. The initial observations were confirmed across multiple pediatric hospitals using the Pediatric Health Information System (PHIS) administrative database.
RESULTS
The single-institution cohort included 338 patients aged 3 days to 20.9 years (median age, 8.6 years); VTE developed in eight (2.4%) patients. The PHIS cohort included 17 634 patients aged from 0 to 21.9 years (median: 9.5 years); VTE developed in 354 (2.0%) patients. Univariate analysis for the single-institution cohort identified central venous catheter (CVC) placement as a risk factor for VTE (odds ratio [OR] 8.40, 95% confidence interval [CI] 1.43-49.41, P = .0186). Multivariable analysis of the PHIS dataset identified CVC placement (OR 1.97, 95% CI 1.57-2.46; P < .0001), obesity (OR 2.96, 95% CI 1.21-7.26; P = .0177), and more than one hospital admission (OR 3.54, 95% CI 2.69-4.64; P < .0001) as significant predictors of VTE. VTE diagnosis was not associated with increased mortality in either cohort.
CONCLUSIONS
The VTE rate in children with CNS tumors is low (2%). CVC placement was identified as a modifiable risk factor in both cohorts.
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28846Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
van Ommen CH, Heijboer H, Buller HR, Hirasing RA, Heijmans HS, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001;139(5):676-681.
Andrew M, David M, Adams M, et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994;83(5):1251-1257.
Woods GM, Sharma R, Creary S, et al. Venous thromboembolism in children with sickle cell disease: a retrospective cohort study. J Pediatr. 2018;197:186-190.
Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-1008.
Setty BA, O'Brien SH, Kerlin BA. Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer. 2012;59(2):258-264.
Johnson KJ, Cullen J, Barnholtz-Sloan JS, et al. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol. Biomark. Prevent. 2014;23(12):2716-2736.
Curtin SC, Minino AM, Anderson RN. Declines in cancer death rates among children and adolescents in the United States, 1999-2014. NCHS Data Brief. 2016(257):1-8.
Thaler J, Ay C, Mackman N, et al. Microparticle-associated tissue factor activity, venous thromboembolism and mortality in pancreatic, gastric, colorectal and brain cancer patients. J Thromb Haemost. 2012;10(7):1363-1370.
Jenkins EO, Schiff D, Mackman N, Key NS. Venous thromboembolism in malignant gliomas. J Thromb Haemost. 2010;8(2):221-227.
Pelland-Marcotte MC, Pole JD, Kulkarni K, et al. Thromboembolism incidence and risk factors in children with cancer: a population-based cohort study. Thromb Haemost. 2018;118(9):1646-1655.
Deitcher SR, Gajjar A, Kun L, Heideman RL. Clinically evident venous thromboembolic events in children with brain tumors. J Pediatr. 2004;145(6):848-850.
Tabori U, Beni-Adani L, Dvir R, et al. Risk of venous thromboembolism in pediatric patients with brain tumors. Pediatr. Blood Cancer. 2004;43(6):633-636.
Jaffray J, Mahajerin A, Young G, et al. A multi-institutional registry of pediatric hospital-acquired thrombosis cases: the Children's Hospital-Acquired Thrombosis (CHAT) project. Thromb Res. 2018;161:67-72.
Daniels SR, Hassink SG. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.
Journeycake JM, Buchanan GR. Catheter-related deep venous thrombosis and other catheter complications in children with cancer. J Clin Oncol. 2006;24(28):4575-4580.
Lo JY, Minich LL, Tani LY, Wilkes J, Ding Q, Menon SC. Factors associated with resource utilization and coronary artery dilation in refractory Kawasaki disease (from the Pediatric Health Information System Database). Am J Cardiol. 2016;118(11):1636-1640.
Witmer CM, Lambert MP, O'Brien SH, Neunert C. Multicenter Cohort Study Comparing U.S. Management of inpatient pediatric immune thrombocytopenia to current treatment guidelines. Pediatr Blood Cancer. 2016;63(7):1227-1231.
Rangarajan HG, Stanek JR, Abu-Arja R, et al. Venous thromboembolism in pediatric hematopoietic cell transplant: a multicenter cohort study. Biol Blood Marrow Transplant. 2018;24(2):337-342.
Kumar R, Stanek J, Creary S, Dunn A, O'Brien SH. Prevalence and risk factors for venous thromboembolism in children with sickle cell disease: an administrative database study. Blood Adv. 2018;2(3):285-291.
Gentilomo C, Huang YS, Raffini L. Significant increase in clopidogrel use across U.S. children's hospitals. Pediatr Cardiol. 2011;32(2):167-175.
Kerlin BA, Smoyer WE, Tsai J, Boulet SL. Healthcare burden of venous thromboembolism in childhood chronic renal diseases. Pediatr Nephrol. 2015;30(5):829-837.
Wedekind MF, Dennis R, Sturm M, Koch T, Stanek J, O'Brien SH. The effects of hospital length of stay on readmissions for children with newly diagnosed acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2016;38(5):329-333.
O'Brien SH, Klima J, Termuhlen AM, Kelleher KJ. Venous thromboembolism and adolescent and young adult oncology inpatients in US children's hospitals, 2001 to 2008. J Pediatr. 2011;159(1):133-137.
Stein PD, Kayali F, Olson RE. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004;145(4):563-565.
Vidal E, Sharathkumar A, Glover J, Faustino EV. Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis. J Thromb Haemost. 2014;12(7):1096-1109.
Mahajerin A, Branchford BR, Amankwah EK, et al. Hospital-associated venous thromboembolism in pediatrics: a systematic review and meta-analysis of risk factors and risk-assessment models. Haematologica. 2015;100(8):1045-1050.
Chen K, Agarwal A, Tassone MC, et al. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis. Blood Coagul Fibrinolysis. 2016;27(4):384-388.
Sharathkumar AA, Mahajerin A, Heidt L, et al. Risk-prediction tool for identifying hospitalized children with a predisposition for development of venous thromboembolism: peds-Clot clinical Decision Rule. J Thromb Haemost. 2012;10(7):1326-1334.
Takemoto CM, Sohi S, Desai K, et al. Hospital-associated venous thromboembolism in children: incidence and clinical characteristics. J Pediatr. 2014;164(2):332-338.
Branchford BR, Mourani P, Bajaj L, Manco-Johnson M, Wang M, Goldenberg NA. Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation. Haematologica. 2012;97(4):509-515.
Mahajerin A, Webber EC, Morris J, Taylor K, Saysana M. Development and implementation results of a venous thromboembolism prophylaxis guideline in a tertiary care pediatric hospital. Hosp Pediatr. 2015;5(12):630-636.
Brandes AA, Scelzi E, Salmistraro G, et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer. 1997;33(10):1592-1596.
Guy JB, Bertoletti L, Magné N, et al. Venous thromboembolism in radiation therapy cancer patients: findings from the RIETE registry. Crit Rev Oncol/Hematol. 2017;113:83-89.
Guy JB, Falk AT, Chargari C, Bertoletti L, Magné N. Thromboembolic events following brachytherapy: case reports. J Contemp Brachyther. 2015;7(1):76-78.
Goldin-Lang P, Niebergall F, Antoniak S, et al. Ionizing radiation induces upregulation of cellular procoagulability and tissue factor expression in human peripheral blood mononuclear cells. Thromb Res. 2007;120(6):857-864.
Brouwer CA, Postma A, Hooimeijer HL, et al. Endothelial damage in long-term survivors of childhood cancer. J Clin Oncol. 2013;31(31):3906-3913.
Blom JW, Vanderschoot JP, Oostindiër MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006;4(3):529-535.
Lin J, Wakefield TW, Henke PK. Risk factors associated with venous thromboembolic events in patients with malignancy. Blood Coagul Fibrinolysis. 2006;17(4):265-270.
Di Nisio M, Candeloro M, Rutjes AWS, Porreca E. Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta-analysis. J Thromb Haemost. 2018;16(7):1336-1346.
Lee I, Adimadhyam S, Nutescu EA, et al. Bevacizumab use and the risk of arterial and venous thromboembolism in patients with high-grade gliomas: a nested case-control study. Pharmacotherapy. 2019;39(9):921-928.
Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States. Cancer. 2013;119(3):648-655.
Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US Children, 1999-2016. Pediatrics. 2018;141(3). https://doi.org/10.1542/peds.2017-3459
Smith TR, Nanney AD 3rd, Lall RR, et al. Development of venous thromboembolism (VTE) in patients undergoing surgery for brain tumors: results from a single center over a 10 year period. J Clin Neurosci. 2015;22(3):519-525.
Nakano F, Matsubara T, Ishigaki T, et al. Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: a Japanese single-center, retrospective study. Thromb Res. 2018;165:95-100.
Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol. 2009;27(29):4839-4847.
Muir M, Patel R, Gadgil N, Pan I, LamS. Postoperative. 30-day outcomes after craniotomy for supratentorial AVM resection in children. J Clin Neurosci. 2019;70:108-112.
Mantia C, Uhlmann EJ, Puligandla M, Weber GM, Neuberg D, Zwicker JI. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood. 2017;129(25):3379-3385.
Carney BJ, Uhlmann EJ, Puligandla M, et al. Anticoagulation after intracranial hemorrhage in brain tumors: risk of recurrent hemorrhage and venous thromboembolism. Res Pract Thromb Haemost. 2020;4(5):860-865.