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

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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.

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Data availability

Not applicable.

Code availability

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Abbreviations

CVAD:

Central venous access device

DVT:

Deep vein thrombosis

LMWH:

Low-molecular-weight heparin

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Author notes

  1. Miguel García-Boyano and José Manuel Caballero-Caballero contributed equally to this work.

Authors and Affiliations

  1. La Paz University Hospital, Madrid, Spain

    Miguel García-Boyano, José Manuel Caballero-Caballero, Marta García Fernández de Villalta, Mar Gutiérrez Alvariño, María Jesús Blanco Bañares & Francisco José Climent Alcalá

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  1. Miguel García-Boyano
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  2. José Manuel Caballero-Caballero
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  3. Marta García Fernández de Villalta
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  4. Mar Gutiérrez Alvariño
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  5. María Jesús Blanco Bañares
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  6. Francisco José Climent Alcalá
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Contributions

Dr. García-Boyano, Dr. Caballero-Caballero, and Dr. Climent Alcalá conceptualized and designed the study, collected data, and drafted the initial manuscript. Dr. García Fernández de Villalta, Dr. Gutiérrez Alvariño, and Dr. Blanco Bañares made substantial contributions to the conception of the work and to the acquisition of data and reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Miguel García-Boyano.

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Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was authorized by the Ethics Committee of our institution.

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Not applicable (retrospective study).

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The authors declare no competing interests.

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Communicated by Peter de Winter

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García-Boyano, M., Caballero-Caballero, J.M., García Fernández de Villalta, M. et al. Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study. Eur J Pediatr 180, 1907–1914 (2021). https://doi.org/10.1007/s00431-021-03985-5

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  • DOI: https://doi.org/10.1007/s00431-021-03985-5

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