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Right atrial thrombi in children with cancer and indwelling catheters
D N Korones1, C J Buzzard, B L Asselin
1Department of Pediatrics, University of Rochester School of Medicine, New York 14642, USA.
Insights
Right atrial thrombi were found in 8.8% of pediatric cancer patients with indwelling catheters. Some thrombi required intervention, while others resolved spontaneously or with anticoagulation.
Area of Science:
- Pediatric Oncology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Indwelling central venous catheters are common in children with cancer.
- Catheter-related thrombi are a known complication, but right atrial thrombi are less frequently reported.
Purpose of the Study:
- To determine the prevalence of right atrial thrombi in pediatric cancer patients with indwelling catheters.
- To describe the characteristics and management of these thrombi.
Main Methods:
- Systematic examination of 156 children with cancer and indwelling catheters using two-dimensional echocardiography.
- Assessment for right atrial thrombi during routine cardiac function screening.
Main Results:
- Right atrial thrombi were detected in 13 children (8.8%).
- Thrombi varied in location (atrial wall vs. catheter tip) and size, with some requiring intervention (surgery or anticoagulation).
- Higher prevalence noted with catheter tips in the right atrium and in patients with acute lymphoblastic leukemia.
Conclusions:
- The incidence of right atrial thrombi in children with indwelling catheters may be higher than previously recognized.
- Echocardiographic screening is crucial for identifying and managing these potentially serious complications.
Objective:
To determine the prevalence of right atrial thrombi in children with cancer and indwelling catheters.
Study Design:
We systematically examined 156 children with cancer and indwelling catheters for the presence of a right atrial thrombus when they underwent routine screening of cardiac function by two-dimensional echocardiography.
Results:
Thirteen children (8.8%) had right atrial thrombi. Of the 13 children, 6 had thrombi adherent to the right atrial wall, and in 5 of these 6 children the clots were considered large enough to require intervention: 2 children with obstruction of venous or tricuspid valve inflow underwent right atriotomy and thrombus removal; they recovered and remained well. The other 3 children had moderate-sized thrombi and were treated with oral anticoagulants; their clots stabilized (2 children) or regressed (1 child). The remaining 7 children had thrombus on the tip of the catheter: 5 of these children were observed; the thrombi spontaneously resolved in 2 of them and did not change in size in the other 3. In the sixth child, the catheter malfunctioned 2 weeks after discovery of the clot and the catheter was removed. The seventh child was treated with warfarin and the clot decreased in size. Thrombi were detected in a greater proportion of children with catheter tips in the right atrium versus the superior vena cava, and in a greater proportion of children with acute lymphoblastic leukemia versus other diagnoses. There was no association between the presence of a clot and duration of time the catheter was in place, the number of catheters placed, treatment with asparaginase, or treatment with total parenteral nutrition.
Conclusion:
The incidence of right atrial thrombi in children with indwelling catheters may be higher than was previously appreciated.