Reduced Physical Activity Levels in Children after Acute Venous Thromboembolism
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INTRODUCTION: Venous thromboembolism (VTE), accompanied by its chronic sequelae such as post-thrombotic syndrome, has reached epidemic proportions. Early identification may offer an opportunity for effective intervention and reduction of long-term morbidity. Currently, no data is available regarding physical activity post-VTE in children and its relation to adverse post-VTE sequelae over time. Therefore, we sought to: (1) assess self-reported physical activity levels in children 6 months post-VTE and change over time from acute diagnosis, (2) compare activity levels of patients with and without adverse post-VTE sequelae, and (3) determine predictors of activity limitations after VTE and assess its association with health related quality of life (HRQoL). METHODS: Data on 50 children ages 2-21 years were extracted from our ongoing TOP study, with 36 diagnosed with lower extremity DVT and PE. We assessed pre-, 3, and 6 months post-VTE physical activity, using the Godin activity questionnaire. Age, race, ethnicity, gender, BMI, site of VTE, clot burden at diagnosis and follow-up, coagulation activation, dyspnea score, 6-minute walk distance (6MWD), and HRQoL were measured during follow-up. RESULTS: Out of 36 subjects, 20 had DVT, 16 had PE, and 3 had both DVT and PE. Of those followed for 12 months, 65% were active at 6 months post-diagnosis compared to 80% before. 36% of subjects had evidence of post-thrombotic sequelae ﾖ a composite of post-thrombotic syndrome per the Manco-Johnson Instrument and post-PE impairment at 12 months post-diagnosis. In multivariate analysis, age, race, ethnicity, gender, BMI, site of VTE, baseline or residual clot burden, and type of anticoagulant were not predictive of activity limitations at 6 months post-VTE. Decreased activity level at 6 months was not associated with a decreased HRQoL at this time. Insufficient activity compared with high activity, reduced 6MWD at 6 months, and coagulation activation (defined by D-dimer > 500 ng/mL at 3 months post-diagnosis) were predictive of increased short-term risk for post-thrombotic sequelae when assessed at 12 months post-diagnosis (OR 1.55, p <0.001; OR 2.7, p=0.02; OR 4.2, p=0.02 respectively). CONCLUSION: 35% of children with DVT and PE had activity limitations post-VTE that adversely influenced short-term post-VTE sequelae. Only 65% of children had resumed their usual activity within 6 months after VTE, highlighting this as a critical time period for interventions aimed at preventing post-VTE disease. Continual data accrual from our ongoing, prospective study may offer further insight to predict risk factors for decreased activity levels and walking distance in children after VTE.
The 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)
Yang, Z., Malone, K., & Zia, A. (2018, January 23). Reduced physical activity levels in children after acute venous thromboembolism. Poster session presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from https://hdl.handle.net/2152.5/5366