Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study

Cohen, Clay T; Anderson, Viia; Desai, Sudhen B.; Arunachalam, Athis; Ahmed, Mubbasheer; Díaz, Rosa

doi:10.1016/j.jpeds.2020.12.061

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…Catheter-related arterial thrombosis is also associated with catheter placement in the umbilical artery, extremities and cardiac catheterization, with surgery being a predisposing factor in 85% of infants less than 6 months of age. [2,[16][17][18]. In a case-control study of venous and arterial thromboembolism, matched for central vascular devices and gestational age, Bhat et al [3] found that male sex [adjusted odds ratio (AOR), 2.12; 95% confidence interval (CI), 1.03-4.35; P ¼ 0.04] and blood culture-positive infections (AOR, 3.47; 95% CI 1.30-9.24; P ¼ 0.01) were significantly and independently associated with venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, catheter-related arterial thrombosis, is viewed as a greater potential risk for complications. In a review of 99 infants [17], all neonates received either unfractionated or LMWH for 28 days in accordance with practice guidelines [29]. Complete, partial, progression and absent thrombus resolution occurred in 60.6, 33.3, 8.1 and 6.1% of the cases, respectively.…”

Section: Management Of Thrombosismentioning

confidence: 99%

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Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study

Paes

Chan²,

Shaik³

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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The incidence of neonatal venous and arterial thrombosis ranges from 6.9 to 15/1000 neonatal ICU (NICU) admissions, and is likely an underestimate based on population demographics, frequency of surveillance and vascular catheterization. This retrospective study involving 234 infants reviewed the epidemiology, diagnosis, and management of neonatal thrombosis in a single, tertiary care institution over more than 10 years. The incidence of thrombosis was 25/1000 NICU admissions, with a preterm to term infant ratio of 1.5 : 1 and a slightly higher proportion of male sex (55.1%). The mean (range) gestational age and birth weight was 33.8 weeks (23-41.6) and 2360 g (512-5890). The median age (IQR) of thrombus diagnosis was 7 (3-17) days. Portal vein thrombosis was most prevalent (59.4%) compared with other sites of thrombosis. Almost three-quarter (171/234; 73.1%) of the thrombotic episodes were line-related, while infection and surgery were associated with 19.7% (46/234) and 10.7% (25/234), respectively. Twenty patients (8.3%) were screened for thrombophilia and 3 were positive; 2 for antithrombin deficiency, 1 for factor V Leiden gene mutation. Subjects were followed with imaging for 3 months with a treatment duration, mean (IQR) of 33.5 (10.8-42.5) days. Complete clot resolution was significantly higher in the anticoagulation group (48%; 17%; P U 0.03) compared with untreated patients. No group difference was noted for partial thrombus resolution (33.3%; 12.4%; P U 0.313). Anticoagulation halted thrombus progression (2.6 versus 12.4%; P U 0.025) and fewer treated patients failed to attend follow-up visits (6.5 versus 18.6%; P U 0.022). Well designed, multicenter prospective studies with larger sample sizes are required to confirm these findings. Blood

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Section: Discussionmentioning

confidence: 99%

Section: Management Of Thrombosismentioning

confidence: 99%

Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study

Paes

Chan²,

Shaik³

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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“…The procedure was defined as successful, if a significant pressure gradient reduction defined as a residual peak-to-peak pressure gradient of less than 20 mmHg or reduced systolic RV pressure less than half of the systemic arterial pressure and an improved opening of the PV with broader contrast jet on angiography was achieved. After cardiac catheterization, low molecular weight heparin was used twice daily for the following 24 h to prevent thromboembolic complications [23,24]. Patients stayed in hospital overnight for clinical observation and were discharged after clinical evaluation, electrocardiogram and echocardiogram one or two days after the procedure.…”

Section: Catheter Proceduresmentioning

confidence: 99%

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Lenoir¹,

Quandt²,

Kretschmar³

et al. 2022

Congenital Heart Disease

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Objectives: Factors influencing results of balloon valvuloplasty (BVP) of pulmonary valve stenosis (PS) in children are investigated. Background: BVP has become the standard of care for PS, medium-term results are not uniform and depend on various preconditions. Methods: We analysed the medium-term results of BVP of PS in children in an observational, single centre study. Need for additional procedure was defined as outcome after initial BVP. Results: We included 143 children (83 female) at a median (IQR) age of 2.6 (0.26-9.24) months and body weight of 5 (3.4-8) kg at BVP with a follow-up of 5.04 (1.6-10.2) years. We used balloon size of 10 (9-14) mm and maximal balloon pressure of 4 (3.5-10) atm, resulting in balloon-to-pulmonary annulus ratio of 1.28 (1.2-1.4). Systolic pressure gradient of PS was reduced with BVP (43.5 mmHg vs. 14.0 mmHg, p < 0.001) and confirmed by echocardiography (68.0 mmHg vs. 25.0 mmHg, p < 0.001) day 1 post procedure. Pulmonary BVP with associated supravalvular PS resulted in a relevant reduction of systolic pressure gradient in 23 of 31 patients (74.2%). Early additional procedure was necessary in 14 patients (9.8%) after 0.2 (0.1-0.7) years due to residual PS (n = 13) and infective endocarditis (n = 1). Factors for additional procedures were associated supravalvular PS with a higher residual pressure gradient, but not genetic syndrome. During further follow-up of 5.04 (1.6-10.2) years no further additional procedures were needed. Conclusions: Pulmonary BVP of native pulmonary valve stenosis leads to excellent medium-term results, even in 3 of 4 infants with associated supravalvular obstruction sufficient pressure relief can be obtained.

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“…Neonatal and infant arterial thrombosis typically occur secondary to cardiac catheterization or indwelling arterial catheters. 11,12 Spontaneous arterial thrombosis is rare, and requires prompt evaluation for underlying anatomical and prothrombotic risk factors. 13 PAI-1 is a serine protease inhibitor that acts as the primary physiological regulator of fibrinolysis by suppressing the generation of active plasmin from plasminogen.…”

Section: E T T E R T O T H E E D I T O R Arterial Thrombosis In a New...mentioning

confidence: 99%

Arterial thrombosis in a newborn with homozygous plasminogen activator inhibitor‐1 4G/4G polymorphism

Sanchez

Snarr

Soni

et al. 2022

Pediatric Blood & Cancer

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Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study

Cited by 9 publications

References 19 publications

Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study

Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study

Medium-Term Results of Balloon Valvuloplasty of Native Pulmonary Valve Stenosis with and without Supravalvular Obstruction in Childhood

Arterial thrombosis in a newborn with homozygous plasminogen activator inhibitor‐1 4G/4G polymorphism

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