Observation of short-term catheter induced thrombosis in children treated with blood purification

Abstract

Background: No studies have assessed the safety of short-term catheter-induced thrombosis in children treated with blood purification. The aim of this study was to determine the incidence and evolution of thrombosis in the children.

Methods: One hundred nineteen (119) children treated with blood purification were enrolled. The data of baseline characteristics, coagulation status and type of catheters were recorded. Thrombosis- related symptoms and signs, ultrasound examinations of the right femoral veins were followed for 2 months. The relationship between associated risk factors (age, sex and type of catheters) and thrombosis was analyzed.

Results: Of the 119 patients, 95 (79.8%) developed deep venous thrombosis (DVT) in the right external iliac veins. In only one patient it was clinically obvious. The incidence of thrombosis had no significant difference between the following subgroups: 1. Children under 6 years (14/15, 93.3%), 6-12 years (63/78, 80.7%) and above 12 years (18/26, 69.2%) (p=0.436); 2. Male (57/66, 86.3%) and female patients (38/53, 71.6%) (p=0.448); 3. Children catheterized with 8F (52/63, 82.5%) and 11F catheters (43/56, 76.7%) (p=0.435). Thrombolysis was achieved in 77 cases (77/80, 96.3%) with treatment of oral dipyridamole at one month and 80 cases (100%) at two months.

Conclusion: Children treated with blood purification through short-term femoral venous catheters have an increased risk of developing DVT, which is usually asymptomatic and good in prognosis. Hippokratia 2014; 18 (3): 245-250.

Keywords: Deep venous thrombosis; blood purification; children; femoral venous catheters; hemoperfusion.

Figure 1. Series of ultrasound scans of catheter-related thrombus in the right external iliac vein in an 8-year-old boy with Henoch - Schönlein purpura who received three daily sessions of hemoperfusion. (A) before catheter removal: thombus size 2.5 cm × 0.47 cm × 0.4 cm; (B) after one month of oral dipyridamole (2mg/kg/d): thombus size 1.5 cm × 0.5 cm × 0.5 cm; (C) after two months of oral dipyridamole (2 mg/kg/d): no thombus was visible. The yellow arrows show the sites of thrombi.