Objective

To investigate treatment modalities for children with extremity indwelling catheter (EIC)- or cardiac catheter-related arterial thrombosis.

Study design

The treatment of consecutive cases of catheter-related arterial thrombosis (CAT) at our institution between 2002 and 2017 was analyzed retrospectively.

Results

A total of 242 CATs developed in 224 children. Of these, 125 (52%) were EIC-related and 117 (48%) were cardiac catheter–related. Treatment included heparin alone in 60 cases (25%), acetylsalicyclic acid (ASA) alone in 6 cases (2%), heparin followed by ASA in 171 cases (71%), heparin followed by vitamin K antagonist (VKA) in 4 cases (1.5%), and VKA alone in 1 case (0.5%). Complete resolution of CAT was observed in 173 cases (71.5%), partial resolution in 13 cases (5.4%), and no resolution in 56 cases (23.1%). No statistical significance in the resolution rate was observed between treatment groups (P = .23). In 66% of cases, complete resolution occurred at a median of 18 days (range, 4-44 days) with heparin alone. A switch from heparin to ASA in children with partial or no resolution of CAT did not increase the resolution rate at follow-up.

Conclusions

Heparin is an efficient treatment modality for CAT in pediatric patients. Long-term, subsequent treatment with ASA does not increase the resolution rate.

中文翻译：

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儿童导管相关动脉血栓形成的治疗：15 年单中心经验

客观的

研究肢体留置导管 (EIC) 或心导管相关动脉血栓形成的儿童的治疗方式。

学习规划

回顾性分析了我院 2002 年至 2017 年间连续发生的导管相关动脉血栓形成 (CAT) 病例的治疗情况。

结果

224 名儿童共发育出 242 种 CAT。其中，125 例 (52%) 与 EIC 相关，117 例 (48%) 与心导管相关。治疗包括单用肝素60例（25%），单用乙酰水杨酸（ASA）6例（2%），171例（71%）用肝素后用ASA，4例用肝素后用维生素K拮抗剂（VKA） (1.5%)，1 例中单独使用 VKA (0.5%)。CAT完全缓解173例（71.5%），部分缓解13例（5.4%），无缓解56例（23.1%）。治疗组间缓解率无统计学意义（P = .23）。在 66% 的病例中，单独使用肝素的中位时间为 18 天（范围为 4-44 天）完全消退。CAT 部分缓解或未缓解的儿童从肝素转换为 ASA 并不会增加随访时的缓解率。

结论

肝素是儿科患者 CAT 的有效治疗方式。ASA 的长期后续治疗不会提高治愈率。