A cross-sectional study evaluating post-thrombotic syndrome in children

Background: Post-thrombotic syndrome (PTS) in adults, characterized by swelling, skin pigmentation, pain, and ulceration of the limb, is secondary to deep vein thrombosis (DVT). In contrast to the extensive documentation on PTS in adults, little is known about the risk of PTS in children. Objective: To determine the incidence, clinical characteristics, and predictors of PTS in children. Methods: A cross-sectional study in 153 nonselected children with objectively confirmed DVT. All children were assessed for PTS using a standardized score. As per the PTS score, severity was classified as: absent, mild, moderate, or severe. Results: Post-thrombotic syndrome was present in 96/153 children (63%), in which 80 (83%) were mild and 16 (17%) were moderate. Swelling was the most frequently recorded subjective symptom (43%) while increased limb circumference (71%) and presence of collateral circulation (53%) were the most frequently recorded objective symptoms. Risk factors for development of PTS were: lack of resolution of the DVT by radiographic assessment (OR 3.96, 95% CI 1.68-9.30), number of vessels involved in the initial DVT (OR 2.05, 95% CI 1.52-2.77), and length of follow-up (OR 1.22, 95% CI 1.08-1.39). Conclusions: These findings demonstrate that PTS is a clinically significant disease in children with previous DVT.