Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Jul;12(7):1096-109.
doi: 10.1111/jth.12598. Epub 2014 Jun 19.

Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis

Affiliations
Meta-Analysis

Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis

E Vidal et al. J Thromb Haemost. 2014 Jul.

Abstract

Objectives: In preparation for a pediatric randomized controlled trial on thromboprophylaxis, we determined the frequency of catheter-related thrombosis in children. We also systematically reviewed the pediatric trials on thromboprophylaxis to evaluate its efficacy and to identify possible pitfalls in the conduct of these trials.

Patients/methods: We searched MEDLINE, EMBASE, Web of Science and the Cochrane Central Register for Controlled Trials for articles published until December 2013. We included cohort studies and trials on patients aged 0-18 years with central venous catheters who underwent active surveillance for thrombosis with radiologic imaging. We estimated the pooled frequency of thrombosis and the pooled risk ratio (RR) with thromboprophylaxis by using a random effects model.

Results: From 2651 articles identified, we analyzed 37 articles with 3128 patients. The pooled frequency of thrombosis was 0.20 (95% confidence interval [CI] 0.16-0.24). In 10 trials, we did not find evidence that heparin-bonded catheters (RR 0.34; 95%CI 0.01-7.68), unfractionated heparin (RR 0.93; 95% CI 0.57-1.51), low molecular weight heparin (RR 1.13; 95% CI 0.51-2.50), warfarin (RR 0.85; 95%CI 0.34-2.17), antithrombin concentrate (RR 0.76; 95% CI 0.38-1.55) or nitroglycerin (RR 1.53; 95%CI 0.57-4.10) reduced the risk of thrombosis. Most of the trials were either not powered for thrombosis or were powered to detect large, probably unachievable, reductions in thrombosis. Missing data on thrombosis also limited these trials.

Conclusions: Catheter-related thrombosis is common in children. An adequately powered multicenter trial that can detect a modest, clinically significant reduction in thrombosis is critically needed. Missing outcome data should be minimized in this trial.

Keywords: anticoagulants; heparin; pediatrics; prevention; prophylaxis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study selection. CVC – central venous catheter; DVT – deep venous thrombosis; RCT – randomized controlled trial.
Figure 2
Figure 2
Random effects meta-analysis showing the individual and pooled frequency of central venous catheter-related deep venous thrombosis (DVT) in children. Squares represent single study estimates of the frequency whereas diamond represents pooled frequency. CI – confidence interval.
Figure 3
Figure 3
Random effects meta-analysis showing the individual and pooled frequency of central venous catheter-related deep venous thrombosis (DVT) in children by type of catheter. Squares represent single study estimates of the frequency whereas diamond represents pooled frequency. CI – confidence interval.
Figure 4
Figure 4
Random effects meta-analysis showing the individual and pooled frequency of central venous catheter-related deep venous thrombosis (DVT) in children by site of insertion of the catheter. Squares represent single study estimates of the frequency whereas diamond represents pooled frequency. CI – confidence interval.
Figure 5
Figure 5
Random effects meta-analysis showing the effect of different agents on the risk for central venous catheter-related deep venous thrombosis in children. Squares represent single trial estimates whereas diamonds represent pooled trial effects. RR – risk ratio; CI – confidence interval.

Comment in

References

    1. Leavitt MO. The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Darby, PA: DIANE Publishing Company; 2009.
    1. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:7S–47S. - PMC - PubMed
    1. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124:1001–8. - PubMed
    1. Raffini L, Trimarchi T, Beliveau J, Davis D. Thromboprophylaxis in a pediatric hospital: A patient-safety and quality-improvement initiative. Pediatrics. 2011;127:e1326–32. - PubMed
    1. Hanson SJ, Punzalan RC, Arca MJ, Simpson P, Christensen MA, Hanson SK, Yan K, Braun K, Havens PL. Effectiveness of clinical guidelines for deep vein thrombosis prophylaxis in reducing the incidence of venous thromboembolism in critically ill children after trauma. J Trauma Acute Care Surg. 2012;72:1292–7. - PubMed

Publication types