1. Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study
- Author
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Miguel García-Boyano, Marta García Fernández de Villalta, Francisco José Climent Alcalá, Mar Gutiérrez Alvariño, José Manuel Caballero-Caballero, and María Jesús Blanco Bañares
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,Deep vein ,Low molecular weight heparin ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Thrombus ,Child ,Retrospective Studies ,Ultrasonography ,Venous Thrombosis ,business.industry ,Anticoagulants ,Retrospective cohort study ,medicine.disease ,Collateral circulation ,Thrombosis ,Surgery ,Venous access ,Venous thrombosis ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
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.
- Published
- 2021
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