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Venous thromboembolism in children with cancer: A population-based cohort study
Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.
Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England; Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Biomed Res Unit, Nottingham, England.ORCID iD: 0000-0002-1135-9356
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2014 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 133, no 3, p. 340-344Article in journal (Refereed) Published
Abstract [en]

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. (C) 2014 The Authors. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 133, no 3, p. 340-344
Keywords [en]
Cancer, Malignancy, Thromboembolism, Venous thrombosis, Children
National Category
Hematology Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-34507DOI: 10.1016/j.thromres.2013.12.021ISI: 000331540400008PubMedID: 24388573Scopus ID: 2-s2.0-84893947356OAI: oai:DiVA.org:oru-34507DiVA, id: diva2:709024
Funder
Swedish Research Council
Note

Funding Agencies:

Cancer Research UK

Nottingham University/Nottingham University Hospitals NHS Trust Senior Clinical Research Fellowship

Swedish Society of Medicine

Available from: 2014-03-31 Created: 2014-03-31 Last updated: 2018-06-05Bibliographically approved

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West, JoeLudvigsson, Jonas F.

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