Risk factors for Venous Thrombo-Embolism (VTE) in children with Sickle Cell Disease (SCD): a multicenter cohort study

Background: A hypercoagulable state resulting in increased VTE has been described in adults with SCD. Similar data for children is lacking. Previously, in a single-institution, retrospective study of 414 pediatric patients with SCD followed at Nationwide Children’s Hospital, we identified central venous catheters (CVC) as an independent risk factor for VTE [OR (± 95%CI): 10.3 (1.1-92.2)]. 12/414 (2.9%) subjects developed VTE over the course of the study. Objectives: The objective of this retrospective, multicenter cohort study was to describe risk factors associated with VTE in children with SCD across children’s hospitals in the United States (US). Results: A total of 8966 unique subjects (4359 female) met inclusion criteria with a mean age (±SD) of 10.3 (±6.4) years. 160 subjects (96 female) developed VTE during the study period. Mean age (±95%CI) at VTE diagnosis was 14.8 (±5.9) years. On multivariate analysis, CRD [OR (±95%CI): 5.2 (2.5-11.1)], any CVC placement [4.2 (3.1-5.9)]; history of stroke [2.5 (1.5-4.1)]; female gender [1.6 (1.1-2.2); and older age at admission [1.1 (1.06-1.12)] were identified as risk factors associated with VTE diagnosis. There was a positive correlation between the number of CVCs placed/1000 patients and the number of VTE diagnosed/1000 patients (p=0.02). Conclusion: Rate of VTE in children with SCD admitted to children’s hospital in the US is around 1.8%. CVC use is associated with a nearly 4-fold increased risk of VTE diagnosis. Additionally, CRD, history of stroke, female gender and older age at admission were also associated with VTE diagnosis. Prospective cohort studies are needed to confirm these findings and develop risk prediction models for VTE in children with SCD. Abstract source