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Updated: Jan 11, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Platelet-related biomarkers and catheter-associated thrombosis in critically ill children: An exploratory study
Hem Regmi1, Irene Li2, Stephanie Prozora1
1Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America.
Insights
Platelet activation markers, P-selectin and IL-6, are linked to catheter-associated deep venous thrombosis (CADVT) in critically ill children. These biomarkers may help identify children needing pharmacologic prophylaxis.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Vascular Biology
Background:
- Critically ill children experience inflammation, leading to platelet activation.
- Platelet activation releases substances that may contribute to thrombosis and bleeding.
- Catheter-associated deep venous thrombosis (CADVT) and clinically relevant bleeding (CRB) are significant complications in this population.
Purpose of the Study:
- To investigate the association between platelet activation and inflammation biomarkers with CADVT and CRB in critically ill children.
- To evaluate the potential of these biomarkers in predicting CADVT.
- To explore the relationship between prophylactic enoxaparin and these biomarkers.
Main Methods:
- Plasma samples were collected from 126 critically ill children (<18 years) with central venous catheters (CVCs) across two multicenter studies.
- Biomarkers of platelet activation (e.g., P-selectin, CD40L, platelet factor 4) and inflammation (e.g., IL-6, TNF-α) were measured.
- Children were monitored for CADVT via ultrasonography and CRB, with data analyzed in relation to biomarker levels and enoxaparin use.
Main Results:
- CADVT occurred in 37.6% and CRB in 31.0% of children.
- Elevated P-selectin and IL-6 levels were associated with CADVT in children not receiving enoxaparin.
- A model incorporating P-selectin and IL-6 demonstrated improved prediction of CADVT compared to clinical factors alone. CRB was linked to high platelet factor 4, and enoxaparin use to high TNF-α.
Conclusions:
- Platelet activation plays a role in the development of CADVT in critically ill children.
- P-selectin and IL-6 show promise as biomarkers for identifying children at high risk for CADVT.
- Further validation of these biomarkers could guide the use of pharmacologic prophylaxis in pediatric intensive care.
Background:
Platelets release different substances when activated, such as during critical illness when children are inflamed. We explored the associations of catheter-associated deep venous thrombosis (CADVT), clinically relevant bleeding (CRB) and prophylactic enoxaparin with biomarkers of platelet activation and inflammation in critically ill children.
Methods:
We analyzed platelet-poor plasma collected from critically ill children <18 years old with central venous catheter (CVC) enrolled in 2 multicenter studies conducted between 2017 and 2024. Blood was obtained on the day of, day after and 4 days after insertion of the CVC. Children were monitored daily for CRB and systematically surveilled for CADVT using ultrasonography. P-selectin, CD40L, platelet factor 4, RANTES, human thrombospondin 1, IL-1β, IL-2, IL-6, IL-8 and TNF-α were measured using immunosorbent assays.
Results:
We studied plasma from 126 children (median: 9.6 years; interquartile range: 1.2, 15.3 years), of whom 24 received prophylactic enoxaparin. CADVT developed in 37.6 % and CRB in 31.0 % of children. Among children without prophylactic enoxaparin, CADVT was associated with high P-selectin and IL-6. A biomarker-augmented model with P-selectin and IL-6 seemed to perform better than a clinical model with age group, severity of illness and platelet count in identifying critically ill children with CADVT. CRB was associated with high platelet factor 4, while prophylactic enoxaparin was associated with high TNF-α.
Conclusions:
Our findings suggest the role of platelet activation in CADVT in critically ill children. Once confirmed, these biomarkers may be used to identify critically ill children who would benefit from pharmacologic prophylaxis.
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