No abstract

The role of thrombophilia testing in predicting catheter-related deep vein thrombosis (DVT) after an incident (ie, first) catheter-related DVT in children remains unclear. The present study investigated the association between thrombophilia and recurrent catheter-related DVT. Children with thrombophilia testing, performed according to the clinician's judgment and the family's preference, and a history of objectively confirmed catheter-related DVT were included in the study. Recurrent catheter-related DVT after placement of a new catheter was the main outcome. Thrombophilia was classified as minor, major, or none. Analysis was conducted using mixed effect logistic regression. A total of 245 patients had 1,365 catheters inserted; 941 of these catheters were placed after the incident catheter-related DVT. Anticoagulants as treatment or prophylaxis were administered in 78.1% of inserted catheters for at least 50% of the time they were in place. Minor thrombophilia was found in 12.7% of patients, whereas major thrombophilia was seen in 8.2% of children. The incidence rate of recurrent events was 0.23/100 catheter-days (95% confidence interval, 0.19-0.28 catheter-days); 34.3% (95% confidence interval, 28.6%-40.0%) of patients requiring a new catheter after their incident thrombotic event had at least 1 recurrent event. The incidence proportion of bleeding complications was 4.6/100 patients receiving anticoagulation. Young age of the patient at the time of catheter insertion and lack of administration of treatment or prophylactic doses of anticoagulant were predictive of recurrent events. In contrast, thrombophilia was not predictive of recurrent catheter-related DVT during subsequent catheter insertions among tested patients. Our findings suggest that thrombophilia testing to predict recurrence in these patients may be unnecessary.

Background/aims: Our understanding of predictors of post-thrombotic syndrome (PTS) in children is evolving. The present study aimed to investigate differences in patient- and DVT-related characteristics between central venous catheter (CVC) and non-CVC-related thrombosis in children and to study early PTS predictors. Methods: Children aged 0-18 years were recruited ≥6 months after imaging-proven upper (UE) or lower extremity (LE) DVT. PTS was measured using CAPTSure©. Early predictors included age at DVT diagnosis, symptoms, DVT burden, and days on therapeutic anticoagulation within 30 days post-DVT. Analysis of predictors was stratified in CVC and non-CVC-related thrombosis. Generalized estimating equations were used for data analyses. Results: In total, 313 DVT-affected extremities of 256 patients were assessed; 275 (88%) DVT were CVC-related. Patients with non-CVC-related thrombosis were older (median 5.8 years, 25th-75th percentile 4.9-6.4 vs. 3.5 months, 25th-75th percentile 0.7-18.7, p<0.001), and had positive thrombophilia (64% vs 22%, p<0.001) and obesity (30% vs. 13%, p=0.01) more frequently than patients with CVC-related thrombosis. PTS CAPTSure© scores were 9.5 points higher (standard error 3.0, p=0.02) in the non-CVC-related thrombosis stratum. Age at the time of DVT predicted PTS in both strata; DVT burden and time from DVT diagnosis to PTS assessment predicted PTS in CVC-related thrombosis. Conclusions: PTS severity was higher in non-CVC-related than in CVC-related thrombosis. Increasing age at the time of DVT is associated with higher PTS severity. DVT burden and time from DVT diagnosis to PTS assessment are significant PTS predictors in CVC-related thrombosis, indicating that long-term follow up of these children is important.