Journal article
Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis
Journal of thrombosis and haemostasis, Vol.12(7), pp.1096-1109
07/01/2014
DOI: 10.1111/jth.12598
PMCID: PMC4107177
PMID: 24801495
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.
Details
- Title: Subtitle
- Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis
- Creators
- E. Vidal - Tulane Univ, Sch Med, Dept Struct & Cellular Biol, New Orleans, LA 70112 USAA. Sharathkumar - University of Iowa, Hematology/OncologyJ. Glover - Yale Univ, Sch Med, Cushing Whitney Med Lib, New Haven, CT USAE. V. S. Faustino - Yale Univ, Sch Med, Dept Pediat, New Haven, CT 06510 USA
- Resource Type
- Journal article
- Publication Details
- Journal of thrombosis and haemostasis, Vol.12(7), pp.1096-1109
- Publisher
- Wiley
- DOI
- 10.1111/jth.12598
- PMID
- 24801495
- PMCID
- PMC4107177
- ISSN
- 1538-7933
- eISSN
- 1538-7836
- Number of pages
- 14
- Grant note
- UL1TR000142 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) National Center for Advancing Translational Science of the National Institutes of Health (NIH) NIH roadmap for Medical Research; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA UL1 TR000142; KL2 TR000140 / CTSA from the National Center for Research Resources
- Language
- English
- Date published
- 07/01/2014
- Academic Unit
- Stead Family Department of Pediatrics; Hematology/Oncology
- Record Identifier
- 9984281449902771
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