Retrospective evalution of the risk factors, treatment and follow-up of children followed with a diagnosis of thrombosis

ABSTRACT Retrospective Evalution of the Risk Factors, Treatment and Follow-Up of Children Followed With a Diagnosis of Thrombosis Introduction and Purpose: Thrombosis is a problem the incidence of which has been gradually increasing in childhood. The prolongation of life expectancy in critically ill patients, the development of new diagnostic and imaging methods and the widespread use of central catheters are held responsible for the increase in the incidence of thrombosis. The aim of this study is to evaluate risk factors, thrombosis localisation areas, treatment responses and recurrence rates of patients who were treated and followed for thrombosis at İnönü University, Faculty of Medicine, Department of Pediatric Haematology Oncology. Material and Methods: Of the 48.609 patients who were hospitalized for various complaints at İnönü University, Faculty of Medicine, Pediatric Health and Diseases Clinic between January 2009 and January 2020, the files of 64 cases who were found to have thrombosis as a result of tests and examinations were reviewed retrospectively. Results: The incidence of thrombosis was found as 17,2/10.000 among the hospitalized patients. The mean age of the 64 patients included in the study was 7,2±6,1. 43.8% of the patients were female, while 56.2% were male. 15.6% of the patients with thrombosis were younger than 1 year old. The families of only 3.1% were found to have a history of thrombosis. 84.9% of the patients included in the study were found to have at least one prothrombotic risk factor. 67.2% of the patients were found to have hereditary risk factors, while 60.9% were found to have acquired risk factors. 42.2% of the patients were found to have both hereditary and acquired risk factors. 29.7% of the patients in the study were found to have thrombosis secondary to infection and thrombosis was mostly found to develop secondary to pneumonia (21.1%) and otitis (15.8%). 14.1% of the patients who developed thrombosis were found to have catheter and the most applied catheter was umbilical (44.4%) catheter. 88.9% of the patients with catheter were in 0-2 age group. 25% of the thrombosis in the patients were arterial, while 75% were venous thrombosis. While the most frequent arterial thrombosis were internal cerebral artery (ICA) (37.5%) and middle cerebral artery (MCA) (37.5%) thrombosis, the most frequent venous thrombosis was portal vein (27.1%) thrombosis. 51.6% of the thrombosis were in cranial region and 17.2% were deep vein thrombosis (DVT). FV Leiden heterozygote mutation was found in 4.7% of the patients, while Prothrombin 20210 A heterozygote mutation was found in 6.3%, MTHFR A1298C heterozygote was found in 31.3% and MTHFR A1298C homozygote mutation was found in 25%. Diagnosis age of the children with catheter and iron deficiency was found to be significantly lower when compared with that of the children who did not have catheter and iron deficiency (p<0.05). Significant difference was found between presence of infection and catheter and thrombosis localization in children included in the study. While thrombosis was detected mostly in the sigmoid and transverse sinus in children with infection (p=0.001), thrombosis was mostly found in portal vein thrombosis in children with catheter (p=0.017). The most frequent hereditary risk factor was found to be the presence of MTHFR A1298C mutation, while the most frequent acquired risk factor was found to be infection. Venous thrombosis was found to occur more frequently than arterial thrombosis. The incidence of portal vein thrombosis was found to be significantly higher in children with iron deficiency when compared with children who did not have iron deficiency (p=0.018). When all patients were evaluated in terms of thrombosis recurrence, only one patient (1.6%) was found to have thrombosis recurrence (right sinus thrombosis). 2 of the patient (3.1%) had been eksitus. Radiological recovery was seen in 46 (71.9%) of the patients, while sequelae was seen in 18 (28.1%). The most frequent sequelae (33.3%) was Budd Chiari syndrome. Conclusion: As a conclusion, it was found in this study that most of the patients with childhood thrombosis had acquired or hereditary risk factors. For this reason, patients who refer with thrombosis in childhood should be researched in terms of risk factors, anti-thrombotic treatment should be started quickly to avoid sequelae and patients with hereditary risk factors should be followed closely. Key Words: Thrombosis, risk factors, childhood