Central venous catheter‐related thrombosis and thromboprophylaxis in children: a systematic review and meta‐analysis

Abstract

To cite this article: Vidal E, Sharathkumar A, Glover J, Faustino EVS. Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis. J Thromb Haemost 2014; 12: 1096-109.Summary. Objectives: In preparation for a pediatric randomized controlled trial on thromboprophylaxis, we determined the frequency of catheter-related thrombosis in children. We also systematically reviewed the pediatric trials on thromboprophylaxis to evaluate its efficacy and to identify possible pitfalls in the conduct of these trials. Patients/Methods: We searched MEDLINE, EMBASE, Web of Science and the Cochrane Central Register for Controlled Trials for articles published until December 2013. We included cohort studies and trials on patients aged 0-18 years with central venous catheters who underwent active surveillance for thrombosis with radiologic imaging. We estimated the pooled frequency of thrombosis and the pooled risk ratio (RR) with thromboprophylaxis by using a random effects model. Results: From 2651 articles identified, we analyzed 37 articles with 3128 patients. The pooled frequency of thrombosis was 0.20 (95% confidence interval . In 10 trials, we did not find evidence that heparin-bonded catheters (RR 0.34; 95%CI 0.01-7.68), unfractionated heparin (RR 0.93; 95% CI 0.57-1.51), low molecular weight heparin (RR 1.13; 95% CI 0.51-2.50), warfarin (RR 0.85; 95% CI 0.34-2.17), antithrombin concentrate (RR 0.76; 95% CI 0.38-1.55) or nitroglycerin (RR 1.53; 95% CI 0.57-4.

Higher-volume hypertonic saline and increased thrombotic risk in pediatric traumatic brain injury

“…17 In the pediatric population, VTE is much less common, with an overall incidence in 0.2-0.6% of hospitalizations. 18 24 The exact mechanism behind acute VTE in critically ill and injured children is yet to be fully understood, the basic pathophysiology underlying all thrombosis hinges on Virchow's triad: circulatory stasis, vascular wall injury and hypercoagulability. 12,25 The critically ill pediatric trauma patient meets criteria for all of these categories: stasis from immobility, vascular wall injury from trauma and/or CVL placement and hypercoagulability from trauma, resuscitation and dehydration.…”

Complicaciones de la nutrición parenteral pediátrica

“…Las técnicas de presión positiva en la retirada de la NP o la infusión pulsátil con un volumen mayor -10 ml-confieren ventajas respecto a métodos convencionales. El empleo de heparina, catéteres impregnados de heparina, heparina de bajo peso molecular o warfarina de forma profiláctica no han demostrado ser una medida eficaz en la prevención de la obstrucción del catéter (7,8).…”

Central venous catheter‐related thrombosis and thromboprophylaxis in children: a systematic review and meta‐analysis: reply

“…Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis: reply We appreciate the insightful comments of Jones and colleagues regarding our systematic review of central venous catheter-related thrombosis and thromboprophylaxis in children [1]. They raised two important points that we would like to address.…”

“…However, we believe that based on current evidence, there is significant concern about the reported frequency of catheter-related thrombosis and its adverse events to justify the conduct of a well-designed trial [2][3][4]. The fact that trials have been conducted before to determine the efficacy of prophylaxis against catheter-related thrombosis points to this concern [1]. Hospitals are also developing local guidelines to prevent thrombosis [5,6].…”