Abstract
Background: Appropriate timing of central venous catheter (CVC) removal, in relation to start of anticoagulation, in children after the diagnosis of a CVC-related thrombosis (CRT) is not well established. Objectives: This retrospective cohort study evaluated the incidence of symptomatic pulmonary embolism (PE) after CVC removal using data from the multi-institutional Children’s Hospital-Acquired Thrombosis (CHAT) Consortium Registry. Patients/Methods: The CHAT Registry consists of data from children aged 0–21 years with a hospital-acquired venous thromboembolism. Eligible subjects were those with CRT diagnosed <3 days after CVC removal. Subjects were excluded if the CRT was due to a failed CVC insertion. Subjects were divided into three groups: those with CVC removal without anticoagulation, those with CVC removal <48 h after starting anticoagulation, and those with CVC removal ≥48 h after starting anticoagulation. Results: A total of 687 CRT events from 663 subjects were included. A majority of CRT events were in subjects with peripherally inserted central catheters (62.3%, n = 428). For the 611 CRT events in which the CVC was removed, there was only one case of symptomatic PE (0.16%), which occurred <48 h after initiation of anticoagulation. Conclusions: While current guidelines suggest anticoagulation before CVC removal in the setting of a CRT to prevent embolization, CVC removal is not associated with symptomatic PE regardless of duration of anticoagulation before CVC removal.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 133-137 |
| Number of pages | 5 |
| Journal | Journal of Thrombosis and Haemostasis |
| Volume | 20 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2022 |
Funding
The authors would like to recognize the effort put forth by the clinical research coordinators at the CHAT Consortium sites that contributed to this study. This work was supported by grants from the National Institutes of Health from the National Center for Advancing Translational Science (grant number UL1TR001855) and The Hemostasis and Thrombosis Research Society Mentored Research Award, supported by an independent educational grant from Takeda Pharmaceuticals U.S.A. (J.J.). We also acknowledge the support of The Saban Research Institute at Children’s Hospital Los Angeles and its Core Pilot Program for the use of the Biostatistics Core (J.J.). N. A. Goldenberg receives salary and research support from NIH NHLBI via a U01 award. There are no other conflicts of interest disclosed for the authors, including J. Jaffray, L. Baumann Kreuziger, B. Branchford, C. P. Wee, E. V. S. Faustino, N. A. Zakai, S. E. Croteau, M. Silvey, J. H. Fargo, J. D. Cooper, N. Bakeer, A. Stillings, E. Krava, and G. Young.
ASJC Scopus subject areas
- Hematology