Postthrombotic syndrome-related chronic limb pain in children: findings from the Multicenter Evaluation of the Duration of Therapy for Thrombosis in Children (Kids-DOTT) trial.

BACKGROUND

Chronic limb pain following an extremity deep venous thrombosis (DVT) in children is a symptom of postthrombotic syndrome (PTS) and can present with or without physical findings of chronic venous insufficiency. Data on the prevalence, phenotype, and risk factors for PTS-related chronic limb pain in pediatrics are limited.

OBJECTIVES

To characterize the prevalence and phenotype of and identify risk factors for PTS-related chronic limb pain in children.

METHODS

We analyzed clinical data from patients with an extremity DVT enrolled in a muticenter clinical trial (NCT00687882). Physical examination findings for PTS and patient-reported outcomes on the presence and severity of pain were obtained at 6 months and 1-year post-DVT diagnosis using the Manco-Johnson Instrument. Risk factors for chronic limb pain at 1 year were evaluated via univariate logistic regression, with odds ratios and 95% CIs. Variables with univariate P < .1 were included in the multivariable analysis.

RESULTS

Among 294 patients, the prevalence of chronic limb pain at 1-year post-DVT was 10% (95% CI, 6.5%-13.3%). In univariate analyses, older age, non-CVC-associated DVT, and prior trauma/surgery were associated with chronic limb pain. Non-CVC-associated DVT remained independently associated with pain (odds ratio, 3.02; 95% CI, 1.08-8.45; P = .035) in the adjusted model.

CONCLUSION

We have identified that 1 in 10 children with provoked DVT experience chronic limb pain at 1-year post-DVT diagnosis and that non-CVC-associated DVT is an independent risk factor for PTS-related chronic limb pain. Future prospective studies and registries are needed to further characterize the phenotype and impact of PTS-related chronic limb pain in children.