Melanie Lissa Schmidt1,2,3, Danielle Wendel4, Simon Peter Horslen4, Erin Richardson Lane4, Leonardo Rodrigues Brandão5, Emily Gottschalk1,2, Christina Belza2, Glenda Courtney-Martin2, Paul William Wales2,6, Yaron Avitzur1,2. 1. Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. 2. Group for Improvement of Intestinal Function and Treatment (GIFT), SickKids Hospital, Toronto, Ontario, Canada. 3. Lawson Research - Pediatrics, London Health Sciences Centre, London, Ontario, Canada. 4. Division of Gastroenterology and Hepatology, Seattle Children's, Seattle, Washington, USA. 5. Division of Hematology and Oncology, Department of Paediatrics, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Division of General and Thoracic Surgery, SickKids Hospital, University of Toronto, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: Catheter-related thrombosis (CRT) is a devastating complication of central venous catheters in children with intestinal failure (IF), but the optimal preventive therapy of CRT is unknown. This study assessed the efficacy and safety of 2 protocols of secondary anticoagulation prophylaxis with low-molecular-weight heparin (LMWH). METHODS: This is a comparative cohort study of children from 2 IF programs who received secondary anticoagulation prophylaxis with LMWH for CRT. The short-term protocol group (N = 13) received therapeutic dosing until thrombus resolution or ≤3 months. In the long-term protocol group (N = 26), prophylactic dosing continued until line removal. Patients underwent routine annual vascular ultrasound and were followed for ≥1 year. The primary outcome was development of secondary thrombosis; post hoc analysis assessed rates of secondary thrombosis at 12 months. RESULTS: Patient demographics were similar between groups. Secondary thrombosis occurred in 8 of 13 (62%) patients in the short-term group and in 9 of 26 (35%) in the long-term protocol group (P = .019) in a median time of 144.5 and 689 days, respectively (P = .01). Secondary thrombosis within 12 months occurred in 7 of 13 (54%, short term) and 2 of 26 (8%, long term) patients (P = .001). Secondary thrombosis was associated with catheter replacements (23.5 vs 5.5 catheters per 1000 catheter days; P = .016) and longer daily parenteral nutrition (PN) infusion (24 vs 15.25 hours; P = .044). Compliance was good (>80% of doses) in 92% of patients. CONCLUSIONS: Long-term secondary anticoagulation prophylaxis with LMWH reduces the incidence of secondary thrombosis and should be considered in children with CRT that require PN for prolonged periods of time.
INTRODUCTION: Catheter-related thrombosis (CRT) is a devastating complication of central venous catheters in children with intestinal failure (IF), but the optimal preventive therapy of CRT is unknown. This study assessed the efficacy and safety of 2 protocols of secondary anticoagulation prophylaxis with low-molecular-weight heparin (LMWH). METHODS: This is a comparative cohort study of children from 2 IF programs who received secondary anticoagulation prophylaxis with LMWH for CRT. The short-term protocol group (N = 13) received therapeutic dosing until thrombus resolution or ≤3 months. In the long-term protocol group (N = 26), prophylactic dosing continued until line removal. Patients underwent routine annual vascular ultrasound and were followed for ≥1 year. The primary outcome was development of secondary thrombosis; post hoc analysis assessed rates of secondary thrombosis at 12 months. RESULTS:Patient demographics were similar between groups. Secondary thrombosis occurred in 8 of 13 (62%) patients in the short-term group and in 9 of 26 (35%) in the long-term protocol group (P = .019) in a median time of 144.5 and 689 days, respectively (P = .01). Secondary thrombosis within 12 months occurred in 7 of 13 (54%, short term) and 2 of 26 (8%, long term) patients (P = .001). Secondary thrombosis was associated with catheter replacements (23.5 vs 5.5 catheters per 1000 catheter days; P = .016) and longer daily parenteral nutrition (PN) infusion (24 vs 15.25 hours; P = .044). Compliance was good (>80% of doses) in 92% of patients. CONCLUSIONS: Long-term secondary anticoagulation prophylaxis with LMWH reduces the incidence of secondary thrombosis and should be considered in children with CRT that require PN for prolonged periods of time.
Authors: I L Vegting; M M Tabbers; M A Benninga; J C Wilde; M J Serlie; T A Tas; C F Jonkers; C H van Ommen Journal: JPEN J Parenter Enteral Nutr Date: 2012-01-12 Impact factor: 4.016
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