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Prophylactic anticoagulation in children receiving home parenteral nutrition

Sjoerd Cornelis Johannes Nagelkerke1,2,3, Melissa H A Schoenmaker4, Merit M Tabbers1,2,3

  • 1Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

JPEN. Journal of Parenteral and Enteral Nutrition
|November 1, 2021
PubMed

Insights

Primary prophylactic anticoagulation in children with intestinal failure (IF) on home parenteral nutrition (HPN) showed a low incidence of catheter-related thrombosis. Clinically relevant bleeding occurred at a slightly elevated rate, indicating a potential benefit for preventing venous thrombosis.

Area of Science:

  • Pediatric Gastroenterology
  • Vascular Access Management
  • Anticoagulation Therapy

Background:

  • Children with intestinal failure (IF) face risks of vascular access loss due to catheter-related venous thrombosis.
  • The efficacy and safety of primary prophylactic anticoagulation in this population are not well-established.

Purpose of the Study:

  • To evaluate the incidence of catheter-related venous thrombosis in children with IF receiving home parenteral nutrition (HPN).
  • To assess bleeding complications associated with primary prophylactic anticoagulation in these pediatric patients.

Main Methods:

  • A cohort of children (0-18 years) on HPN at a single center was followed from 2007 to 2019.
  • Primary prophylactic anticoagulation was offered to all patients from the initiation of HPN.
  • Key outcomes measured were catheter-related venous thrombosis and bleeding events.

Main Results:

  • Of 74 patients, 55 (76%) received prophylactic anticoagulation.
  • The incidence of catheter-related thrombosis was 0.2 per 1000 catheter days.
  • The incidence of clinically relevant bleeding was 0.1 per 1000 catheter days, with 5-year event-free survival for thrombosis at 78%.

Conclusions:

  • Primary prophylactic anticoagulation in children with IF on HPN is associated with a low rate of catheter-related venous thrombosis.
  • A slightly elevated rate of clinically relevant bleeding was observed.
  • The findings suggest a potential role for prophylactic anticoagulation in managing vascular access in this vulnerable pediatric group.
Abstract

Keywords:
catheter-related thrombosischronic intestinal failurelow molecular weight heparinpediatricvitamin K antagonist

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