Venous Thromboembolism in Pediatric Cancer Patients with Central Venous Catheter—A Systematic Review and Meta-analysis

Abstract

Pediatric cancer patients hold an increased risk of venous thromboembolism (VTE) due to their cancer. Central venous catheters (CVCs) further increase the VTE risk. This systematic literature review elucidates the VTE incidence in pediatric cancer patients with CVC. MEDLINE and EMBASE were searched in August 2020 without time limits. We included studies reporting original data on patients ≤18 years with any CVC type and any cancer type, who were examined for VTE with ≥7 days follow-up. In total, 682 unique records were identified, whereof 189 studies were assessed in full text. Altogether, 25 studies were included, containing 2,318 pediatric cancer patients with CVC, of which 17% suffered VTE. Fifteen studies (n = 1,551) described CVC-related VTE and reported 11% CVC-related VTE. Concerning cancer type, 991 children suffered from acute lymphoblastic leukemia (ALL) and 616 from solid tumors. Meta-analysis revealed VTE incidence (95% confidence interval) of 21% (8–37) for ALL and 7% (0.1–17) for solid tumors. Additionally, 20% of children with tunneled or nontunneled CVC and 12% of children with implantable ports suffered VTE. In conclusion, pediatric cancer patients with CVC have substantial VTE risk. Children with ALL and CVC have higher VTE incidence than children with solid tumors and CVC. Implantable port catheter should be preferred over tunneled or nontunneled CVC to reduce VTE risk. Thrombophilia investigation does not seem relevant in pediatric cancer patients with CVC and VTE. To prevent VTE, intensified catheter care is recommended, especially in children with ALL.

Technical Feasibility and Safety of Central Venous Ports for Intravenous Chemotherapy in Infants With Retinoblastoma: A Retrospective Study

“…No VTE was observed in this study. Meta-analysis of VTE in pediatric cancer patients with the central venous system revealed a VTE incidence of 21% (95% CI:8-37); 20% had tunneled or non-tunneled CVCs, and 12% had implantable ports [ 16 ]. Regarding VTE, CVP may be preferable to CVC in pediatric patients with cancer.…”

The prevalence of thrombocytopenia in patients with acute cancer-associated thrombosis

“…There was a higher prevalence of DVT in the hematologic malignancy group compared to solid tumor group (69% vs 41%) driven largely by higher rates of upper extremity DVT (34% vs 12%) which is attributed to the frequent use of catheter thrombosis in hematologic malignancy. [28,29] Severe thrombocytopenia is commonly observed in patients with hematologic malignancies.…”

The Evaluation of Central Venous Catheter-related Complications in Pediatric Acute Leukemia Patients: Single Center Experience

“…In a recently published meta-analysis evaluating CVC-related thrombosis in pediatric cancer patients, the rate of thrombosis in patients with ALL was found to be the highest at 21%. 19 Glucocorticoids and L-asparaginase, used in the treatment of ALL, are possible causative agents. 20 It is not recommended to test for thrombophilia in CVC-related venous thrombosis in cancer patients and we did not test for forms of congenital thrombophilia in the patients in our study.…”

“…We did not find any difference in terms of sex or age between the groups with and without vascular complications. In a recently published meta-analysis evaluating CVC-related thrombosis in pediatric cancer patients, the rate of thrombosis in patients with ALL was found to be the highest at 21% 19. Glucocorticoids and l -asparaginase, used in the treatment of ALL, are possible causative agents 20.…”