Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

• Published in: European journal of pediatrics 2021-06, Vol.180 (6), p.1907-1914
• Main Authors: García-Boyano, Miguel, Caballero-Caballero, José Manuel, García Fernández de Villalta, Marta, Gutiérrez Alvariño, Mar, Blanco Bañares, María Jesús, Climent Alcalá, Francisco José
• Format: Article
• Language: English
• Subjects: Anticoagulants; Blood clots; Child; Children; Diagnosis; Female; Humans; Male; Medicine; Medicine & Public Health; Multivariate analysis; Occlusion; Original Article; Patients; Pediatrics; Retrospective Studies; Risk Factors; Thrombosis; Ultrasonography; Ultrasound; Veins; Veins & arteries; Venous access; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - drug therapy; Venous Thrombosis - etiology
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-021-03985-5

The risk factors associated with the probability of central venous access device (CVAD)-associated deep vein thrombosis (DVT) resolution have been hardly evaluated in children. Current guidelines suggest anticoagulation for a maximum of 3 months in patients with provoked DVT if the provoking factor is resolved. To know if the thrombus will resolve after anticoagulant therapy will help to choose whether to initiate and/or continue this treatment or not. We did a retrospective study of 85 pediatric patients (45 girls, 40 boys) with CVAD-associated DVT to examine the risk factors associated with lack of thrombus resolution in the first 6 months after diagnosis. Sixty-two children had their thrombosis resolved after a median of 50 days (p25-p75 25–97) since diagnosis. In multivariate analysis, variables significantly associated with no resolution were total occlusion (OR 12.50, 95% CI 2.99–52.14, p =.001), location in upper extremity, head, and neck veins (OR 17.70, 95% CI 1.64–191.43, p =.018); collateral circulation in the first 45 days after diagnosis (OR 33.55, 95% CI 2.42–464.71, p =.009); and having between 0 and 3 prothrombotic risk factors at diagnosis (OR 6.20, 95% CI 1.21–31.75, p =.029). Conclusion : CVAD-associated DVT resolution in children in the first 6 months since diagnosis was significantly lower if the thrombosis was occlusive, if it was located in the upper extremity, head, and neck veins; if collateral circulation was seen on ultrasound in the first 45 days; and/or when the patient showed less prothrombotic risk factors at diagnosis. What is Known: • The risk factors associated with central venous access device-associated deep vein thrombosis resolution have been hardly evaluated in children. • Current guidelines suggest anticoagulation for a maximum of 3 months in provoked vein thrombosis if the provoking factor is resolved. What is New: • Thrombus resolution was lower if it was occlusive, located in the upper extremity veins, if collateral circulation was seen, and with less prothrombotic risk factors at diagnosis. • To know if the thrombus will resolve after anticoagulation will help to choose whether to initiate and/or continue it or not.