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Secondary Anticoagulation Prophylaxis for Catheter‐Related Thrombosis in Pediatric Intestinal Failure: Comparison of Short‐ Vs Long‐Term Treatment Protocols
Author(s) -
Schmidt Melanie Lissa,
Wendel Danielle,
Horslen Simon Peter,
Lane Erin Richardson,
Brandão Leonardo Rodrigues,
Gottschalk Emily,
Belza Christina,
CourtneyMartin Glenda,
Wales Paul William,
Avitzur Yaron
Publication year - 2021
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.2055
Subject(s) - medicine , thrombosis , dosing , parenteral nutrition , low molecular weight heparin , surgery , catheter , venous thrombosis , complication , cohort , incidence (geometry) , thrombus , anesthesia , physics , optics
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.