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Venous thromboembolism in children with cancer – a population-based cohort study

Walker, Alex J.; Grainge, Matthew J.; Card, Timothy R.; West, Joe; Ranta, Susanna; Ludvigsson, Jonas F

Authors

Alex J. Walker alex.walker@nottingham.ac.uk

Matthew J. Grainge matthew.grainge@nottingham.ac.uk

Timothy R. Card tim.card@nottingham.ac.uk

Joe West joe.west@nottingham.ac.uk

Susanna Ranta

Jonas F Ludvigsson



Abstract

Introduction: Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce.

Materials and methods: We conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data. From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We calculated VTE incidence rates in children with cancer vs. controls, and hazard ratios (HRs) using Cox regression.

Results: We identified four VTE events in children with cancer compared with four events in the larger control population corresponding to absolute risks of 1.52 and 0.06 per 1000 person-years respectively. The four children with VTE and cancer were diagnosed with hematological, bone or non-specified cancer. Childhood cancer was hence associated with a highly increased risk of VTE (HR adjusted for age and sex: 28.3; 95%CI = 7.0-114.5).

Conclusions: Children with cancer are at increased relative risk of VTE compared to those without cancer. Physicians could consider thromboprophylaxis in children with cancer to reduce their excess risk of VTE however the absolute risk is extremely small and the benefit gained therefore would need to be balanced against the risk invoked of implementing such a strategy.

Novelty & Impact Statements: While there is a reasonable level of knowledge about the risk of VTE in adult populations, it is not well known whether this risk is reflected in paediatric patients. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. While this finding is important, the absolute risk of VTE is still low and must be balanced with the risks of anticoagulation.

Journal Article Type Article
Publication Date Mar 1, 2014
Journal Thrombosis Research
Print ISSN 0049-3848
Electronic ISSN 1879-2472
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 133
Issue 3
APA6 Citation Walker, A. J., Grainge, M. J., Card, T. R., West, J., Ranta, S., & Ludvigsson, J. F. (2014). Venous thromboembolism in children with cancer – a population-based cohort study. Thrombosis Research, 133(3), doi:10.1016/j.thromres.2013.12.021
DOI https://doi.org/10.1016/j.thromres.2013.12.021
Keywords Cancer; Malignancy; Thromboembolism; Venous thrombosis; Children
Publisher URL http://www.sciencedirect.com/science/article/pii/S0049384813006075
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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