PB0044 - Pediatric arterial thrombosis: patient characteristics and thrombosis outcomes

Background: Arterial thrombosis (AT) is an increasingly recognized complication in pediatrics. Consensus clinical practice guidelines suggest immediate removal of indwelling arterial catheter and short course (5-7 days) of anticoagulation.1 The optimal duration and modality of antithrombotic therapy in children is yet to be determined.

Aims: 1. Describe clinical characteristics, risk factors, anticoagulation treatment and outcomes in pediatric patients with AT 2. Explore associated clinical and treatment factors that led to thrombosis resolution

Methods: Single institution retrospective chart review study. Patients were identified by ICD-9 and ICD-10 codes for diagnosis of AT or reports of AT on ultrasound from Jan, 2012 to Oct, 2022. Descriptive and logistic regression analyses were used.

Results: 101 patients with AT were identified. Median age at diagnosis was 2.2 months. Most common underlying diagnoses were congenital heart disease (39.6%), infection (22.8%) and malignancy (4%). Majority of patients had symptomatic thrombosis in an extremity, 78% were line-associated. 82/101 received anticoagulation, 34 patients received antiplatelet therapy and 9 patients underwent thrombectomy or vascular graft. Median duration of anticoagulation was 17 days (range 2-242 days, excluding 5 patients on lifelong anticoagulation).
Out of the 70 patients who were treated with anticoagulation alone and had a follow up study, 75% had complete resolution after 90 days of anticoagulation (Figure 1). No clear predictors of complete resolution were identified in this study (Table 1). 21 patients had long term sequelae including ischemia/amputation, leg length discrepancy, claudication or short gut syndrome. Major and clinically relevant non-major bleeding rate was 11%.

Conclusion(s): Duration of anticoagulation was widely variable in our study, majority of patients achieved complete resolution by 90 days of anticoagulation therapy with median duration of 17 days. Significant proportion of patients developed long-term sequelae secondary to arterial insufficiency. Further studies are recommended to identify optimal duration and modality of antithrombotic therapy in children with AT.