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Systemic Catheter-Related Venous Thromboembolism in Children: Data From the Italian Registry of Pediatric Thrombosis
Donatella Lasagni1, Margherita Nosadini2, Angelo Claudio Molinari3
1Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.
Insights
Central venous catheter (CVC) use in children is a significant risk for venous thrombotic events (VTEs). This registry study highlights the incidence, characteristics, and outcomes of CVC-related VTEs in pediatric patients.
Area of Science:
- Pediatric Thrombosis
- Vascular Access Devices
- Clinical Registry Studies
Background:
- Central venous catheters (CVCs) are a primary risk factor for venous thrombotic events (VTEs) in pediatric populations.
- Understanding CVC-related VTEs (CVC-VTEs) is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the incidence, clinical presentation, and management of CVC-VTEs in children.
- To provide data for enhancing the detection and management of CVC-related complications in pediatric patients.
Main Methods:
- A registry-based study utilizing data from the Italian Registry of Pediatric Thrombosis (RITI).
- Analysis of radiologically confirmed CVC-VTEs in children aged 29 days to 18 years over 6.5 years.
- Inclusion of 78 CVC-VTE events in 76 patients.
Main Results:
- 78 CVC-VTEs were analyzed, with 53% occurring in males. Most events were non-cardiac (86%).
- Symptomatic CVC-VTEs occurred in 77% of cases, with a median onset of 10 days for non-cardiac VTEs.
- Anti-thrombotic treatment was administered in 96% of cases; no CVC-VTE-related deaths were reported, though complications like post-thrombotic syndrome occurred.
Conclusions:
- This study provides valuable insights into CVC-VTEs in Italian children.
- The findings can aid in the improved detection and management strategies for this significant complication.
Background:
Central venous catheters (CVCs) represent one of the main risk factors for venous thrombotic events (VTEs) in children.
Methods:
We studied the Italian Registry of Pediatric Thrombosis (RITI) with regard to systemic radiologically confirmed CVC-related VTEs (CVC-VTEs) occurred during 6.5 years in children aged 29 days to 18 years.
Results:
A total of 78 CVC-VTEs were included, which occurred in 76 patients (40/76, 53% males). CVC-VTEs comprised 67 non-cardiac VTEs (86%) and 11 intracardiac thrombotic events (ICTEs) (14%); the median age at onset was 19 and 17 months, respectively. The most frequent reason for CVC insertion was supportive therapy. The catheters were placed percutaneously in 85% of cases (56/66) and surgically in the remaining 15% (10/66). Peripherally inserted central catheters (PICCs) were used in 47% (31/66) cases, partially implanted catheters in 42% (28/66), non-implantable catheters in 7% (5/66), and totally implanted catheters (Port) in 2% (1/66). CVC-VTEs were symptomatic in 77% of cases (60/78), while in the remaining 23%, they were incidentally detected on the imaging performed for the underlying condition. The median time between CVC insertion and the onset of symptoms was 10 days in non-cardiac VTEs and 39 days in ICTEs. Doppler ultrasound was the diagnostic technique most frequently used. The venous compartment most frequently affected was the veins of the lower extremities (52%, 43/73). Anti-thrombotic treatment was administered in 96% of CVC-VTEs (75/78). About 2.6% (2/76) of patients experienced a second thrombotic event. At discharge, post-thrombotic syndrome was reported in 13.5% (5/37) events with available data, CVC replacement in 10.8% (4/47), and ischemic necrosis with toe finger amputation in 2.7% (1/37). Three patients died due to an underlying condition; no CVC-VTE-related deaths were reported.
Conclusions:
We have carried out a registry-based study on CVC-VTEs in the children in Italy, providing the data that may help improve the detection and management of this CVC-related complication.
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