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Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis

E Vidal1, A Sharathkumar, J Glover

  • 1Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.

Journal of Thrombosis and Haemostasis : JTH
|May 8, 2014
PubMed

Insights

Catheter-related thrombosis is common in children, affecting 20% of those with central venous catheters. Current thromboprophylaxis strategies show no significant benefit, highlighting the need for a well-powered trial to confirm efficacy.

Area of Science:

  • Pediatric Thrombosis Research
  • Vascular Access Complications
  • Clinical Trial Methodology

Background:

  • Catheter-related thrombosis (CRT) is a significant complication in pediatric patients with central venous catheters.
  • Understanding the frequency of CRT is crucial for developing effective prevention strategies.
  • Existing pediatric thromboprophylaxis trials have limitations that need to be addressed.

Purpose of the Study:

  • To determine the frequency of catheter-related thrombosis in pediatric patients.
  • To systematically review existing pediatric thromboprophylaxis trials to assess efficacy.
  • To identify methodological pitfalls in previous pediatric thrombosis trials.

Main Methods:

  • Systematic search of multiple databases (MEDLINE, EMBASE, Web of Science, Cochrane) up to December 2013.
  • Inclusion of cohort studies and trials involving pediatric patients (0-18 years) with central venous catheters.
  • Pooled frequency and risk ratios (RR) for thrombosis were estimated using random-effects models.

Main Results:

  • Analysis of 37 articles involving 3128 patients revealed a pooled CRT frequency of 20% (95% CI: 0.16-0.24).
  • Ten trials found no significant evidence that various thromboprophylaxis methods (heparin-bonded catheters, unfractionated heparin, LMWH, warfarin, antithrombin, nitroglycerin) reduced thrombosis risk.
  • Most trials were underpowered or aimed to detect unrealistically large reductions in thrombosis, with missing outcome data being a limitation.

Conclusions:

  • Catheter-related thrombosis is a prevalent issue in pediatric populations.
  • There is a critical need for a large, multicenter trial with adequate power to detect clinically meaningful reductions in pediatric CRT.
  • Future trials must prioritize minimizing missing outcome data to ensure reliable results.
Abstract

Keywords:
anticoagulantsheparinpediatricspreventionprophylaxis

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