Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

Abstract

Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.