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Prophylactic Anticoagulation Decreases Catheter‐Related Thrombosis and Occlusion in Children With Home Parenteral Nutrition
Author(s) -
Vegting I. L.,
Tabbers M. M.,
Benninga M. A.,
Wilde J. C.,
Serlie M. J.,
Tas T. A.,
Jonkers C. F.,
Ommen C. H.
Publication year - 2012
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 - 10.1177/0148607111416482
Subject(s) - parenteral nutrition , medicine , thrombosis , catheter , intensive care medicine , occlusion , surgery
Background : Home parenteral nutrition (PN) has improved the survival of children with intestinal failure. Important complications include catheter‐related thrombosis, occlusion, and infection. This study evaluated the efficacy and safety of prophylactic anticoagulation in the prevention of these complications. Methods : Medical records were retrospectively reviewed of all children (0–18 years) with PN between January 1994 and March 2007 in 1 tertiary center. After introduction of prophylactic low molecular weight heparin or vitamin K antagonists in March 2007, all patients were prospectively followed until March 2010. Results : In sum, 14 patients did not receive prophylaxis; 13 switched from no prophylaxis to prophylaxis in March 2007; and 5 directly received prophylaxis. Median age of PN onset was 4 months (range, 0.1–202) in the nonprophylaxis group (n = 27) and 25 (range, 2–167) in the prophylaxis group (n = 18); 16 children received low molecular weight heparin and 2, vitamin K antagonists. Catheter‐related thrombosis developed in 9 patients with no prophylaxis (33%) and 1 with prophylaxis (6%) ( P = .034). Cumulative 5‐year thrombosis‐free survival was 48% and 93% in the nonprophylaxis and prophylaxis groups, respectively ( P = .047). Per 1,000 PN days, the nonprophylaxis and prophylaxis groups had 2.6 and 0.1 occlusions ( P = .04) and 4.6 and 2.1 infections ( P = .06), respectively. Cumulative infection‐free survival after 3 years was 19% and 46% in the nonprophylaxis and prophylaxis groups, respectively ( P = .03). Bleeding complications did not occur. Conclusion : Thromboprophylaxis significantly decreased catheter‐related thrombosis and occlusion in children with PN without complications.