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Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, Goldenberg NA, Grabowski E, Heller C, Journeycake J, Kenet G, Krümpel A, Kurnik K, Lubetsky A, Male C, Manco-Johnson M, Mathew P, Monagle P, van Ommen H, Simioni P, Svirin P, Tormene D, Nowak-Göttl U. Impact of Inherited Thrombophilia on Venous Thromboembolism in Children. Circulation 2008; 118:1373-82. [DOI: 10.1161/circulationaha.108.789008] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background—
The aim of the present study was to estimate the impact of inherited thrombophilia (IT) on the risk of venous thromboembolism (VTE) onset and recurrence in children by a meta-analysis of published observational studies.
Methods and Results—
A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2007 was conducted using key words in combination as both MeSH terms and text words. Citations were independently screened by 2 authors, and those meeting the inclusion criteria defined a priori were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, VTE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios and 95% CIs were calculated with both fixed-effects and random-effects models. Thirty-five of 50 studies met inclusion criteria. No significant heterogeneity was discerned across studies. Although >70% of patients had at least 1 clinical risk factor for VTE, a statistically significant association with VTE onset was demonstrated for each IT trait evaluated (and for combined IT traits), with summary odds ratios ranging from 2.63 (95% CI, 1.61 to 4.29) for the factor II variant to 9.44 (95% CI, 3.34 to 26.66) for antithrombin deficiency. Furthermore, a significant association with recurrent VTE was found for all IT traits except the factor V variant and elevated lipoprotein(a).
Conclusions—
The present meta-analysis indicates that detection of IT is clinically meaningful in children with, or at risk for, VTE and underscores the importance of pediatric thrombophilia screening programs.
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Affiliation(s)
- Guy Young
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Manuela Albisetti
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Mariana Bonduel
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Leonardo Brandao
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Anthony Chan
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Frauke Friedrichs
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Neil A. Goldenberg
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Eric Grabowski
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Christine Heller
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Janna Journeycake
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Gili Kenet
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Anne Krümpel
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Karin Kurnik
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Aaron Lubetsky
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Christoph Male
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Marilyn Manco-Johnson
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Prasad Mathew
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Paul Monagle
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Heleen van Ommen
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Paolo Simioni
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Pavel Svirin
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Daniela Tormene
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Ulrike Nowak-Göttl
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
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