Treatment-Related Outcomes in Paget–Schroetter Syndrome—A Cross-Sectional Investigation - 09/12/18

Doi : 10.1016/j.jpeds.2018.11.018

Riten Kumar, MD, MSc ^1,^2,^* , Katherine Harsh, BS ³, Surbhi Saini, MD ^4,⁵, Sarah H. O'Brien, MD, MSc ^1,², Joseph Stanek, MS ¹, Patrick Warren, MD ^2,⁶, Jean Giver, APN ¹, Michael R. Go, MD ⁷, Bryce A. Kerlin, MD ^1,²
¹ Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH
² Department of Pediatrics, The Ohio State University, Columbus, OH
³ College of Medicine, The Ohio State University, Columbus, OH
⁴ Division of Pediatric Hematology/Oncology, Hershey Children's Hospital, Hershey, PA
⁵ Department of Pediatrics, Penn State University, Hershey, PA
⁶ Division of Interventional Radiology, Nationwide Children's Hospital, Columbus, OH
⁷ Department of Vascular Diseases and Surgery, The Ohio State University, Columbus, OH

^*Reprint requests: Riten Kumar, MD, MSc, Nationwide Children's Hospital, The Ohio State University, 700 Children's Dr, Columbus, OH 43205.Nationwide Children's HospitalThe Ohio State University700 Children's DrColumbusOH43205

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 09 December 2018

Abstract

Objective

To investigate treatment-related outcomes, namely radiological clot resolution, post-thrombotic syndrome (PTS), and health related quality-of-life (HRQoL) scores, in children with Paget–Schroetter syndrome (PSS) undergoing multidisciplinary management, including anticoagulation and decompressive rib-resection surgery, with or without thrombolytic therapy.

Study design

We identified all patients treated for PSS at our institution between the years 2010 and 2017. Baseline clinical and radiologic data were abstracted from medical records. Two validated survey instruments to quantify PTS and HRQoL were mailed to eligible patients. Standard statistical methods were used to summarize these measures.

Results

In total, 22 eligible patients were identified; 10 were treated with thrombolysis followed by anticoagulation and rib resection, and 12 were treated with anticoagulation and rib resection alone. Nineteen patients responded to the survey instruments. Median age at deep vein thrombosis diagnosis and survey completion were 16.3 and 20.4 years, respectively. Nineteen of 22 patients had thrombus resolution on radiologic follow-up. Fourteen of 19 survey respondents reported signs/symptoms of PTS of which the majority (12/14) reported mild PTS. Aggregate total, physical, and psychosocial HRQoL scores reported were 90.6, 96.7, and 93.3, respectively. Thrombolytic therapy was not associated with a significant improvement in radiologic, clinical or HRQoL outcomes.

Conclusions

Most patients with PSS had complete thrombus resolution on imaging. Only 11% of survey respondents reported moderate PTS. The entire cohort reported excellent HRQoL scores. The role for thrombolytic therapy in the management of childhood PSS remains incompletely elucidated.

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Keywords : Paget–Schroetter syndrome, venous thromboembolism, thrombolysis, post-thrombotic syndrome

Abbreviations : DVT, HRQoL, NCH, PSS, PTS

Plan

Methods

Thrombophilia Testing

Study Cohort and Management Details

	The authors declare no conflicts of interest.
	Portions of this study were presented at the American Society of Hematology (ASH) annual meeting, December 11, 2017, Atlanta, Georgia.