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Central venous thrombosis in children with intestinal failure on long-term parenteral nutrition
Jessica Gonzalez-Hernandez1, Yahya Daoud1, Jennifer Styers2
1Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
Insights
Children with intestinal failure on parenteral nutrition face high central venous thrombosis risk. Low anticoagulant proteins and high factor VIII indicate potential liver issues contributing to this complication.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Vascular Medicine
Background:
- Central venous thrombosis (CVT) is a significant risk for children requiring long-term central venous access for parenteral nutrition (PN) due to intestinal failure (IF).
- Understanding the incidence and risk factors for CVT is crucial for managing these vulnerable patients.
Purpose of the Study:
- To investigate the incidence of central venous thrombosis (CVT) in children with intestinal failure (IF) receiving long-term parenteral nutrition (PN).
- To identify potential risk factors associated with the development of CVT in this pediatric population.
Main Methods:
- A retrospective review of children with IF on home PN from 2010-2014 who underwent central venous imaging.
- Comparison of demographic data, catheter characteristics, complications, liver function markers, and thrombophilia markers between children with and without CVT.
Main Results:
- Out of 30 children reviewed, 17 had at least one thrombosed central vein, and 12 had two or more.
- Children with CVT exhibited significantly lower albumin levels compared to those without CVT.
- Common thrombophilia markers in CVT patients included antithrombin, protein C and S deficiencies, and elevated factor VIII; a combined deficiency in protein C and S correlated with multiple CVTs.
Conclusions:
- Children with IF on long-term PN are at a high risk for CVT.
- Low levels of natural anticoagulant proteins and elevated factor VIII activity, possibly due to liver insufficiency and chronic inflammation, are likely contributors to CVT development.
Purpose:
Central venous thrombosis (CVT) is a serious complication of long-term central venous access for parenteral nutrition (PN) in children with intestinal failure (IF). We reviewed thse incidence of CVT and possible risk factors.
Methods:
Children with IF on home PN (2010-2014) with central venous imaging were reviewed. Patient demographics, catheter characteristics and related complications, and markers of liver function were compared between children with and without CVT. Serum thrombophilia markers were reviewed for patients with CVT.
Results:
Thirty children with central venous imaging were included. Seventeen patients had thrombosis of ≥1 central vein, and twelve had ≥2 thrombosed central veins. Patients with and without CVT had similar demographics and catheter characteristics. Patients with CVT had a significantly lower albumin level (2.76±0.38g/dL vs. 3.12±0.41g/dL, p=0.0223). The most common markers of thrombophilia in children with CVT were antithrombin, protein C and S deficiencies, and elevated factor VIII. There was a statistically significant correlation between a combined protein C and S deficiency and having >1 CVT.
Conclusions:
Children with IF on long-term PN are at high risk for CVT potentially owing to low levels of natural anticoagulant proteins and elevated factor FVIII activity, likely a reflection of liver insufficiency and chronic inflammation.
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