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Published on: September 20, 2019

Warfarin therapy in children who require long-term total parenteral nutrition

Fiona Newall1, Chris Barnes, Helen Savoia

  • 1Department of Paediatrics, University of Melbourne, Women's and Children's Health, Parkville, Australia.

Pediatrics
|November 5, 2003
PubMed

Insights

Warfarin prophylaxis is safe and effective for preventing blood clots in children requiring long-term total parenteral nutrition (TPN). This therapy may also extend the lifespan of central venous access devices (CVADs) in pediatric patients.

Area of Science:

  • Pediatric Hematology
  • Clinical Nutrition
  • Vascular Access Management

Background:

  • Children requiring long-term total parenteral nutrition (TPN) are at risk for central venous access device (CVAD)-related thrombosis.
  • Effective anticoagulation strategies are crucial for managing these pediatric patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of warfarin for preventing CVAD-related thrombosis in children receiving long-term TPN.
  • To assess the impact of warfarin on CVAD survival in this population.

Main Methods:

  • Prospective cohort study involving 8 pediatric patients with short-gut syndrome or intestinal anomalies.
  • Warfarin therapy managed by a pediatric hematology department, with data on demographics, nutrition, CVADs, and adverse events collected.
  • Monitoring of international normalized ratio (INR) to maintain a therapeutic range of 2.0 to 3.0.

Main Results:

  • The study covered 15.2 warfarin-years, achieving the target INR range 51.1% of the time.
  • Mean warfarin dose was 0.33 mg/kg/d. No major bleeding events or thrombosis progression occurred.
  • Mean CVAD duration increased from 160.9 days before warfarin to 351.7 days with therapy.

Conclusions:

  • Warfarin can be safely administered to children requiring long-term TPN for CVAD-related thrombosis prophylaxis.
  • This study is the first to report uniform warfarin prophylaxis for CVADs in children.
  • Warfarin prophylaxis appears to prolong CVAD survival in pediatric patients.
Abstract

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