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. 2025 Apr;51(3):335-342.
doi: 10.1055/s-0044-1800967. Epub 2024 Dec 18.

Recurrent Thromboembolism in Pediatric Congenital Heart Disease: Cumulative Incidence and Prognostic Factors

Amy L Kiskaddon  1   2   3   4 , Therese M Giglia  5 , Marisol Betensky  6   7 , Nhue L Do  8   9 , Daniel M Witt  10 , Arabela C Stock  3   11 , Ernest K Amankwah  12   13 , Jamie L Fierstein  12   14 , Dina Ashour  12 , Vera Ignjatovic  2 , James A Quintessenza  3 , Neil A Goldenberg  2   6   7   15
Affiliations

Recurrent Thromboembolism in Pediatric Congenital Heart Disease: Cumulative Incidence and Prognostic Factors

Amy L Kiskaddon et al. Semin Thromb Hemost. 2025 Apr.

Abstract

Congenital heart disease (CHD) is a risk factor for thromboembolism (TE). Data describing the rate of, and risk factors associated with, recurrent TE in children with CHD are limited. We prospectively evaluated TE recurrence risk in children with CHD and acute TE and investigated clinical risk factors associated with recurrent TE. Patients < 21 years of age with CHD and acute TE were enrolled in a single-institutional prospective inception cohort study (July 2013-April 2024). Descriptive statistics summarized variables including CHD and thrombus characteristics, antithrombotic regimens, bleeding, and recurrent TE. Multivariable logistic regression determined risk factors for recurrent TE. Among 40 children with CHD and acute TE, 13 (33%) developed ≥ 1 recurrent TE (arterial n = 1 [6%], venous n = 15 [83%], venous + arterial n = 2 [11%]) at a median time of 86 (interquartile range, 45-112) days postdiagnosis of the index TE. One-year cumulative incidence of recurrent TE was 38%. Twelve (67%) recurrent TE events were central venous catheter (CVC)-related. In univariable analyses, immobility (46% vs. 7%, p = 0.01), the presence of a CVC (69% vs. 30%, p = 0.02), and lower extremity index venous TE (89% vs. 41%, p = 0.04) were associated with TE recurrence. After adjustment for other potential risk factors via multivariable logistic regression, immobility (adjusted odds ratio [OR] 13.2, 95% confidence interval [CI] 1.16-151.3, p = 0.04) and the presence of a CVC (adjusted OR 5.28, 95% CI 1.03-27.1, p = 0.05) remained as independent risk factors for recurrent TE. The 1-year risk of TE recurrence was high among pediatric patients with CHD and acute TE. Immobility and the presence of CVC were independent risk factors for recurrent TE. Multicenter prospective cohort studies are warranted to substantiate and expand upon these important findings.

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Conflict of interest statement

N.A.G. receives research support and salary support from the National Institutes of Health and the National Heart Lung and Blood Institute for clinical and translational investigation in venous thromboembolism in patients < 21 years old. He receives or has recently received (past 12 months) consultancy fees from Anthos Therapeutics, Bayer, and the University of Colorado-affiliated Academic Research Organization CPC Clinical Research for roles in clinical trial planning or oversight committees (e.g., advisory committee; steering committee; data and safety monitoring committee) in pharmaceutical industry-sponsored pediatric multicenter clinical trials of antithrombotic agents. He also receives consultancy fees from Novartis for data and safety monitoring committee membership in multicenter clinical trials of an immunomodulatory agent. His employer, Johns Hopkins University, receives salary support on his behalf from Boehringer-Ingelheim for data coordinating center leadership for a pediatric antithrombotic multicenter prospective observational study.M.B. receives research support and salary support from the National Institutes of Health and the National Heart Lung and Blood Institute for clinical and translational investigation in venous thromboembolism in patients < 21 years old.E.K.A. has recently received (in the past 12 months) consultancy fees from Boehringer-Ingelheim.D.M.W. has received research and salary support from the Agency for Healthcare Research and Quality for clinical and translational investigation in warfarin therapy patient self-management in adult patients.All other authors have nothing to disclose.