Risks of incident venous thromboembolism, recurrent thromboembolism, and use of antithrombotic therapies, among children with congenital heart disease undergoing cardiac surgery: A global multicenter analysis of real-world data

Authors

Amy L. Kiskaddon, Divisions of Cardiology and Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA; Department of Pharmacy, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. Electronic address: amy.kiskaddon@jhmi.edu.
Nhue L. Do, Advocate Health - MidwestFollow
Ernest K. Amankwah, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA; Quantitative Sciences Division, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
Daniel M. Witt, Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Vera Ignjatovic, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA.
Therese M. Giglia, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Gary M. Woods, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hilary B. Whitworth, Division of Cardiac Critical Care, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Arabela C. Stock, Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Division of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neil A. Goldenberg, Institute for Clinical and Translational Research, Johns Hopkins All Children's, St. Petersburg, FL, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA; Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.

Recommended Citation

Kiskaddon AL, Do NL, Amankwah EK, et al. Risks of Incident Venous Thromboembolism, Recurrent Thromboembolism, and Use of Antithrombotic Therapies, Among Children with Congenital Heart Disease Undergoing Cardiac Surgery: A Global Multicenter Analysis of Real-World Data. J Thromb Haemost. Published online March 14, 2025. doi:10.1016/j.jtha.2025.03.005

Affiliations

Advocate Children's Hospital

Abstract

Background:Data on the characteristics and antithrombotic treatments of venous thromboembolism (VTE) among children with congenital heart disease (CHD) undergoing cardiac surgery are limited.

Objective:(s): To evaluate the features and rates of recurrent thromboembolism in real-world experience, using a global multicenter dataset.

Methods:We queried the TriNetX global electronic health record (EHR)-derived real-world data research platform for patients <18 years of age who underwent cardiac surgery for CHD with a diagnosis of VTE within 1 year of surgery. Data on patient and VTE characteristics, antithrombotic therapies, and recurrent thromboembolism were descriptively analyzed.

Results:Of 24,879 children, 1475 (5.9%) developed an acute incident VTE within 1 year of surgery. Lower extremity deep venous thrombosis (DVT, n=999, 67.7%) was the most common VTE type, and the Glenn procedure was the most common surgery type (n=432, 29.3%). Unfractionated heparin was utilized for acute (<7 days post-diagnosis) and subacute (≥ 7 days to 3 months post-diagnosis) VTE treatment in 1022 (69.3%) and 895 (60.7%) patients, respectively. The 1-year rate of recurrent thromboembolism was high (n=372, 25%), most of which were lower extremity DVT (n=305, 81.9%).

Conclusions:Approximately 6% of children undergoing cardiac surgery develop VTE within one year. The 1-year risk of thromboembolism recurrence is 25%. Prospective multicenter studies are essential to identify factors associated with the occurrence and recurrence of venous thromboembolism (VTE) in children undergoing cardiac surgery. This research will provide valuable insights for future interventional trials focused on preventing incident and recurrent VTE in this vulnerable population.

Document Type

Article

PubMed ID

40090621