Risk factors and co-morbidities in adolescent thromboembolism are different than those in younger children

•Adolescent thromboembolism is multi-factorial with several risk factors reported.•The majority of our cohort had ≥ 2 risk factors at diagnosis.•Notable associations in our cohort included obesity, CVC, infection, and surgery.•Time to recurrence was shorter for those with occlusive thrombi.•Detailed evaluation of thromboembolism risk factors is warranted in adolescents.

IntroductionIn adolescent thromboembolism (TE), multiple risk factors (RFs) and co-morbidities (CMs) are reported, though overall prevalence has not been evaluated. We hypothesized that the spectrum of RFs/CMs in adolescent TE differs from children overall and sought to review Texas Children's Hospital's experience.Patients/methodsMedical records of adolescents aged 12-21 years, diagnosed with arterial or venous TE (AT/DVT) from 2004 to 2014, were retrospectively reviewed and analyzed with IRB approval.ResultsSixty-four adolescents (median age 16, range 12-20 years) met study criteria. Fifty-seven (89%) had DVT and six (9%) had AT. Associated RFs/CMs included obesity (47%), CVC (27%), infection (27%), surgery (27%), autoimmune disease (19%), immobility (22%), anatomical abnormality (20%), cancer (8%), estrogen therapy (6%), tobacco use (6%), trauma (3%), inherited thrombophilia (19%), and other medical conditions (11%). Fifty-two (81%) had ≥ 2 RFs/CMs. Therapy included anticoagulants, antiplatelet agents, and interventional therapy. Of those with follow-up imaging, 49 had complete or partial resolution, 5 had no change and 4 had progression. Fourteen (22%) had recurrent TE. The majority with recurrent TE (79%) had ≥ 2 RFs at initial diagnosis. Mean time to recurrence was 4.80 years; time to recurrence was shorter for occlusive TE (p = 0.026).ConclusionAdolescent TE is often multi-factorial with the majority having ≥ 2 RFs at diagnosis, suggesting the need for detailed evaluation for RFs in this population, which may enable optimal management including thromboprophylaxis, and institution of RF-modifying strategies to prevent occurrence/recurrence.