Hospital acquired venous thromboembolism in children with sickle cell disease

Abstract

Sickle cell disease (SCD) is well recognized as a hypercoagulablestate, however, it remains unclear whether a subgroup of children with SCD at higher risk of venous thromboembolic event (VTE) during hospitalization may benefit from thromboprophylaxis. Our objectives were to describe the clinical characteristics, outcomes and recurrence of hospital acquired VTE in patients with SCD younger than 21 years. This was a single center retrospective study. Data regarding demographics, reason for admission, location of VTE, risk factors like central venous catheter (CVC), intensive care unit (ICU) admission among others were extracted from electronic medical records over a 10-year study period (2011–2021). Recurrence of VTE at 1 and 5 years was assessed. Descriptive statistics were used as indicated. We identified a total of 20 VTE events over the 10-year study period. Six of these events occurred in those younger than 12 years of age. Fourteen (70%) VTE events occurred in the HbSS or HbSβThal0 genotypes compared to 6 (30%) in HbSC. Most common VTE was isolated pulmonary embolism (PE) (n = 10, 50%). VTE were most often associated with acute chest syndrome (ACS) (n = 14, 70%), ICU admissions (n = 10, 50%) and CVC (n = 5/9, 55%). One patient died from the VTE event. One patient with additional underlying risk factors had a recurrent VTE at 13 months. Our study suggests that ICU admission, ACS and presence of CVC increases the risk of VTE in children and young adults with SCD, but larger studies are indicated to validate our findings.

Keywords:

• Thrombosis
• pediatrics
• sickle cell disease
• thromboprophylaxis

Disclosure statement

The authors have no conflicts of interest to disclose.

Funding/support

None.

Role of funder/sponsor

Not applicable.

Clinical trial registration

Not applicable.

Contributors statement

Drs Shreya Agarwal, Kayla L Foster, Shaniqua J Anum, Hyo Jeong Han, Mary C. Shapiro and Sarah E. Sartain conceptualized and designed the study, collected data, critically reviewed, and revised the manuscript. Drs Shreya Agarwal and Sarah E. Sartain drafted the initial manuscript. Dr Gladstone Airewele conceptualized the study, critically reviewed and revised the manuscript. Dr Michael Scheurer performed data analysis, critically reviewed and revised the manuscript. All authors approved the final manuscript and agreed to be accountable for all aspects of the work.