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Semin Thromb Hemost 2011; 37(7): 802-809
DOI: 10.1055/s-0031-1297171
© Thieme Medical Publishers

Impact of Persistent Antiphospholipid Antibodies on Risk of Incident Symptomatic Thromboembolism in Children: A Systematic Review and Meta-Analysis

Gili Kenet1 , Sofia Aronis2 , Yackov Berkun3 , Mariana Bonduel4 , Anthony Chan5 , Neil A. Goldenberg6 , Susanne Holzhauer7 , Alfonso Iorio8 , Janna Journeycake9 , Ralf Junker10 , Christoph Male11 , Marilyn Manco-Johnson5 , Patti Massicotte12 , Rolf Mesters13 , Paul Monagle14 , Heleen van Ommen15 , Leslie Rafini16 , Paolo Simioni17 , Guy Young18 , Ulrike Nowak-Göttl10
  • 1The Israel National Haemophilia Centre, Sheba Medical Centre, Tel-Hashomer, Israel
  • 2Haemophilia Centre-Haemostasis Unit, Aghia Sophia Children's Hospital, Athens, Greece
  • 3The Department of Pediatrics, Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
  • 4Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. JP Garrahan,” Buenos Aires, Argentina
  • 5Thrombosis and Atherosclerosis Research Institute McMaster University, Hamilton, Ontario, Canada
  • 6Department of Pediatrics and Medicine, Hematology/Oncology/BMT, University of Colorado and The Children's Hospital, Denver, Colorado
  • 7Department of Pediatric Hematology/Oncology, Charite, Berlin, Germany
  • 8Departments of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
  • 9Department of Pediatrics, Children's Medical Centre Dallas, University of TX Southwestern, Medical Centre Dallas, Texas
  • 10Department of Clinical Chemistry, University Hospital of Kiel, Kiel, Germany
  • 11Department for Pediatrics, Medical University Vienna, Vienna, Austria
  • 12Department of Pediatrics, University Children Hospital Alberta, Canada
  • 13Department of Internal Medicine, University Hospital of Münster, Münster, Germany
  • 14The Royal Children's Hospital, Victoria, Australia
  • 15Department of Pediatric Hematology, Emma Children's Hospital AMC, Amsterdam, The Netherlands
  • 16Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
  • 17Department of Medical & Surgical Sciences, University of Padua, Padua, Italy
  • 18Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California
Further Information

Publication History

Publication Date:
20 December 2011 (online)

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ABSTRACT

The aim of this study was to estimate the impact of antiphospholipid (aPL) antibodies on the risk of incident thromboembolism (TE; arterial and venous) in children via meta-analysis of published observational studies. A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1966 to 2010 was conducted using keywords in combination both as MeSH terms and text words. Two authors independently screened citations and those meeting the a priori defined inclusion criteria were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, TE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either fixed-effects or random-effects models. Of 504, 16 pediatric studies met the inclusion criteria. In total 1403 patients and 1667 population-based controls ≤18 years were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. Thus, data from arterial and venous TE were analyzed together. In addition, meta-regression analysis did not reveal statistically significant differences between site of TE, age at first TE, country, or publication year. A statistically significant association with a first TE was demonstrated for persistent aPL antibodies, with an overall summary ORs/CI of 5.9/3.6–9.7 (arterial 6.6/3.5–12.4; deep vein thrombosis 4.9/2.2–10.9). The present meta-analysis indicates that detection of persistent aPL is clinically meaningful in children with, or at risk for, TE and underscores the importance of pediatric thrombophilia screening programs.

KEYWORDS

Antiphospholipid antibodies - thromboembolism - recurrence - children - meta-analysis

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Ulrike Nowak-GöttlM.D. 

Hemostasis Unit, Department of Clinical Chemistry, University Hospital of Kiel

Arnold-Heller-Str. 3, D-24105 Kiel, Germany

Email: leagottl@gmail.com