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Prophylactic anticoagulation decreases catheter-related thrombosis and occlusion in children with home parenteral

I L Vegting1, M M Tabbers, M A Benninga

  • 1Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital / Academic Medical Center, Amsterdam, Netherlands.

JPEN. Journal of Parenteral and Enteral Nutrition
|January 17, 2012
PubMed

Insights

Prophylactic anticoagulation significantly reduced catheter-related thrombosis and occlusion in children receiving home parenteral nutrition (PN). This intervention improved thrombosis-free survival and decreased catheter-related infections without causing bleeding complications.

Area of Science:

  • Pediatric Gastroenterology
  • Hematology
  • Clinical Nutrition

Background:

  • Home parenteral nutrition (PN) is crucial for managing pediatric intestinal failure but carries risks of catheter-related complications.
  • Key complications include catheter-related thrombosis, occlusion, and infection, impacting patient survival and quality of life.
  • Evaluating prophylactic anticoagulation is essential for mitigating these risks in children on long-term PN.

Purpose of the Study:

  • To assess the efficacy of prophylactic anticoagulation in preventing catheter-related thrombosis, occlusion, and infection in pediatric patients on home PN.
  • To evaluate the safety of prophylactic anticoagulation, specifically monitoring for bleeding complications.

Main Methods:

  • Retrospective review of medical records for children (0-18 years) on PN from January 1994 to March 2007.
  • Prospective follow-up of patients from March 2007 to March 2010 after the introduction of prophylactic low molecular weight heparin or vitamin K antagonists.
  • Comparison of complication rates between patients receiving and not receiving prophylactic anticoagulation.

Main Results:

  • Catheter-related thrombosis occurred in 33% of the non-prophylaxis group versus 6% in the prophylaxis group (P = .034).
  • Cumulative 5-year thrombosis-free survival was significantly higher in the prophylaxis group (93%) compared to the non-prophylaxis group (48%) (P = .047).
  • Occlusion rates were lower with prophylaxis (0.1 per 1000 PN days) than without (2.6 per 1000 PN days) (P = .04), and infection rates showed a trend towards reduction (2.1 vs 4.6 per 1000 PN days, P = .06).
  • Cumulative 3-year infection-free survival was 46% with prophylaxis versus 19% without (P = .03).
  • No bleeding complications were reported in either group.

Conclusions:

  • Prophylactic anticoagulation significantly reduces the incidence of catheter-related thrombosis and occlusion in children receiving home parenteral nutrition.
  • Anticoagulation therapy is safe and effective in preventing major catheter-related complications, improving long-term outcomes for pediatric patients with intestinal failure.
  • The findings support the routine use of thromboprophylaxis in pediatric patients on long-term PN.
Abstract

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