Thromboembolism risk factors in children with CVC
Abstract:
Background: Acutely ill and medically complex children frequently rely on central venous catheters (CVCs) to provide life-sustaining treatment. Unfortunately, catheter related thrombosis (CRT) is a serious and common complication. Little is known why some with a CVC develop CRT and others develop a venous thromboembolism (VTE) unrelated to a CVC (non-CRT).
Objective: The aim of this study was to identify factors associated with CRT in children with (hospital-acquired) HA-VTE.
Methods: This case-case study included participants within the Children’s Hospital Acquired Thrombosis (CHAT) Registry with HA-VTE and CVC aged 0-21 years from eight U.S. children’s hospitals. Participants were excluded if they developed HA-VTE prior to CVC insertion or the CVC insertion date was unknown. Logistic regression models were used to assess associations between clinical factors and CRT status.
Results: There were 1144 participants with HA-VTE who had a CVC. CRT developed in 833 participants and 311 developed a non-CRT. Multivariable analysis showed an increased odds of CRT (compared to non-CRT) in participants with peripherally inserted central catheters [odds ratio (OR)=3.80, 95% confidence interval (CI)=2.04-7.10, p<0.001], CVCs inserted in the femoral vein (OR=4.45, 95% CI=1.70-11.65, p=0.002), having multiple CVCs (OR=1.42, 95% CI=1.18-1.71, p<0.001) and having a CVC malfunction (OR=3.30, 95% CI=1.80-6.03, p<0.001).
Conclusions: The findings of this study provide new insights on risk factor differences between CRT and non-CRT. Prevention efforts should be directed at modifying the type of CVC, insertion location and/or number of CVCs placed if possible, to decrease the incidence of CRT.
Reference:
Jaffray J, Mosha M, Branchford B, Goldenberg NA, Silvey M, Croteau SE, Fargo JH, Cooper JD, Bakeer N, Stillings A, Krava E, Young G, Amankwah EK. Evaluation of Venous Thromboembolism Risk Factors Reveals Subtype Heterogenicity in Children with Central Venous Catheters: A Multi-Center Study from the CHAT Consortium. J Thromb Haemost. 2023 Apr 24:S1538-7836(23)00336-7. doi: 10.1016/j.jtha.2023.03.045. Epub ahead of print. PMID: 37100395.