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Multicenter Study
. 2025 Nov;23(11):3633-3639.
doi: 10.1016/j.jtha.2025.03.005. Epub 2025 Mar 14.

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

Amy L Kiskaddon  1 , Nhue L Do  2 , Ernest K Amankwah  3 , Daniel M Witt  4 , Vera Ignjatovic  5 , Therese M Giglia  6 , Gary M Woods  7 , Hilary B Whitworth  8 , Arabela C Stock  9 , Neil A Goldenberg  10
Affiliations
Multicenter Study

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

Amy L Kiskaddon et al. J Thromb Haemost. 2025 Nov.

Abstract

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

Objectives: We aimed 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-derived real-world data research platform for patients <18 years of age who underwent cardiac surgery for congenital heart disease 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 (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 after diagnosis) and subacute (≥7 days to 3 months after 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 deep venous thrombosis (n = 305, 81.9%).

Conclusion: Approximately 6% of children undergoing cardiac surgery develop VTE within 1 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 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.

Keywords: congenital cardiac surgery; congenital heart disease; pediatric venous thromboembolism.

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Conflict of interest statement

Declaration of competing interests 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 (eg, advisory committee, steering committee, and 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. 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. A.L.K., N.L.D., V.I., T.M.G., G.M.W., H.B.W., and A.C.S. have no competing interests to disclose.

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