Abstract
Objectives: Sickle cell disease (SCD) is well recognized as a
hypercoagulable state, however venous thromboembolism (VTE) risk factors
in children remain largely unknown. In this study, we aim to describe
the clinical characteristics, outcomes and recurrence of hospital
acquired VTE in patients younger than 21 years of age. Study
Design/Methods: Data were extracted from electronic medical records
over a 10-year period (2011-2021). Data regarding sickle cell genotype,
demographics, reason for admission, location of thrombus, presence of
central venous catheter (CVC), intensive care unit (ICU) admission,
presence of thrombophilia risk factors, resolution of VTE, mortality,
and bleeding outcomes on anticoagulation were collected. Recurrence of
VTE at 1 and 5 years was assessed. Descriptive statistics were used as
indicated. Results: We identified a total of 21 VTE events over
the ten-year study period. Six of these events occurred in those younger
than 12 years of age. Fifteen (71%) VTE events occurred in the HbSS or
HbSβThal 0 genotypes compared to 8 (29%) in HbSC.
Eleven (52%) patients were admitted with acute chest syndrome (ACS).
Most VTE events were associated with ICU admissions (n=13, 62%) and
presence of central venous catheter (n=12, 57%). Major bleeding on
anticoagulation occurred in 10%.All patients had resolution of index
VTE at 12 weeks. Recurrence rate for VTE at 5 years was 13%. One
patient died from the VTE event. Conclusions: Our study
highlights that VTE can complicate SCD in children and young adults.
Hospital acquired VTE were most associated with ICU admission, CVC, and
ACS, but larger studies are indicated to validate our findings.