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Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study

Fabio Paglialonga1, Andrea Artoni2, Simon Braham2

  • 1Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabiopaglialonga@alice.it.

Pediatric Nephrology (Berlin, Germany)
|December 16, 2015
PubMed

Insights

Vitamin K antagonists (VKA) therapy in children on chronic hemodialysis (HD) with central venous catheters (CVC) appears safe and improves CVC survival. This study suggests VKA may reduce CVC malfunction in pediatric patients at high risk for thrombosis.

Area of Science:

  • Pediatric Nephrology
  • Vascular Access Management
  • Anticoagulation Therapy

Background:

  • Limited research exists on vitamin K antagonist (VKA) use in pediatric patients undergoing chronic hemodialysis (HD) with central venous catheters (CVC).
  • Central venous catheter (CVC) malfunction and thrombosis are significant concerns in pediatric patients requiring chronic HD.

Purpose of the Study:

  • To investigate the safety and efficacy of VKA therapy in children with CVC for chronic HD.
  • To assess the impact of VKA on CVC survival and malfunction rates in pediatric patients.

Main Methods:

  • A cohort of pediatric patients (<18 years) with newly placed tunnelled CVC for chronic HD were enrolled.
  • Patients with active nephrotic syndrome or history of venous thrombosis received warfarin (VKA group); others received standard care (standard group).
  • The primary endpoint was overall CVC survival, with secondary evaluation of CVC malfunction and bleeding events.

Main Results:

  • The VKA group (9 patients, 11 CVCs) demonstrated significantly longer 6- and 12-month CVC survival compared to the standard group (8 patients, 10 CVCs) (100% vs. 60% and 83.3% vs. 16.7%, respectively).
  • Median CVC survival was notably longer in the VKA group (369 days) versus the standard group (195 days).
  • No CVCs in the VKA group required removal due to malfunction, contrasting with four in the standard group; no major bleeding occurred in either group.

Conclusions:

  • Vitamin K antagonist (VKA) therapy is a safe option for children on chronic HD requiring CVC.
  • VKA therapy may significantly improve CVC survival and reduce malfunction in pediatric patients at increased risk of thrombosis.
  • This study supports considering VKA for enhancing vascular access longevity in specific pediatric hemodialysis populations.
Abstract

Keywords:
Oral anticoagulantsPaediatric haemodialysisTunnelled central venous catheterVitamin K antagonistsWarfarin

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