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Anticoagulation results in increased line salvage for children with intestinal failure and central venous thrombosis

Cory M McLaughlin1, Monica Bennett2, Nandini Channabasappa3

  • 1Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.

Journal of Pediatric Surgery
|March 4, 2018
PubMed

Insights

Anticoagulation therapy in children with intestinal failure and central venous thrombosis reduced bloodstream infections and catheter replacements. It may also prevent clot propagation, though further research on optimal dosing is needed.

Area of Science:

  • Pediatric Thrombosis
  • Vascular Access Management
  • Parenteral Nutrition Complications

Background:

  • Central venous thrombosis (CVT) is a significant complication in children with intestinal failure (IF) requiring parenteral nutrition.
  • Catheter-associated thrombosis can lead to serious complications, including bloodstream infections and loss of vascular access.
  • Limited data exist on the efficacy of anticoagulation in this specific pediatric population.

Purpose of the Study:

  • To evaluate the impact of anticoagulation (AC) on thrombus resolution in children with IF and CVT.
  • To assess whether AC improves central venous catheter (CVC) longevity by reducing complications.
  • To determine the effect of AC on the frequency of catheter-related infections and mechanical failures.

Main Methods:

  • Retrospective review of pediatric patients with IF and CVT from 2006-2017.
  • Comparison of catheter-related complications (infection, occlusion, breakage) 18 months before and after initiating AC.
  • Assessment of thrombus resolution via re-imaging during AC.
  • Statistical analysis using Poisson regression (p<0.05 significance).

Main Results:

  • Eighteen children with CVT were identified; subclavian vein thrombosis was most common (44%).
  • Low molecular weight heparin (LMWH) was used for AC; 33% of patients showed clot resolution.
  • Bloodstream infections decreased significantly during AC (7.9 to 4.4 per 1000 catheter days, p=0.01).
  • Catheter replacements due to infection also decreased significantly (3.0 to 1.0 per 1000 catheter days, p=0.01).
  • No significant changes in line occlusions or breakages were observed.

Conclusions:

  • Anticoagulation may be beneficial in preventing thrombus propagation in pediatric IF patients with CVT.
  • AC therapy is associated with a reduction in bloodstream infections and the need for catheter replacement.
  • Further investigation is warranted to establish optimal AC dosing and treatment duration for this patient group.
Abstract

Keywords:
AnticoagulationCatheterCentral venous thrombosisIntestinal failureShort bowel syndromeThromboprophylaxis

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