Central venous catheters (CVC) are the most significant risk factor for pediatric venous thromboembolism (VTE). After an index CVC-associated VTE (CVC-VTE), the role of secondary prophylaxis for subsequent CVC placement is uncertain. Aims of this single-center retrospective study were to evaluate the efficacy of secondary prophylaxis for patients with a prior CVC-VTE and identify risk factors associated with recurrent VTE in patients less than 19 years with an index CVC-VTE between 2003 and 2013. Data collection included clinical and demographic factors, subsequent CVC placement, secondary prophylaxis strategy, recurrent VTE, and bleeding. Risk factors for recurrence and effectiveness of secondary prophylaxis were evaluated using survival and binomial models. Among 373 patients with an index CVC-VTE, 239 (64.1%) had subsequent CVC placement; 17.4% (65/373) of patients had recurrent VTE, of which 90.8% (59/65) were CVC-associated. On multivariable survival analysis, each additional CVC (hazards ratio [HR] 12.00; 95% confidence interval [CI] 2.78-51.91), congenital heart disease (HR 3.70; 95% CI 1.97-6.95), and total parenteral nutrition dependence (HR 4.02; 95% CI 2.23-7.28) were associated with an increased hazard of recurrence. Full dose anticoagulation for secondary prophylaxis was associated with decreased odds of recurrent CVC-VTE (odds ratio [OR] 0.35; 95% CI 0.19-0.65) but not prophylactic dosing (OR 0.61; 95% CI 0.28-1.30). Only 1.3% of CVCs experienced major bleeding with prophylactic or full-dose anticoagulation. In summary, children with CVC-VTE are at increased risk for recurrent VTE. Secondary prophylaxis with full-dose anticoagulation was associated with a 65% reduction in odds of thrombotic events.

中文翻译：

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预防中心静脉导管相关静脉血栓形成儿童的复发性血栓事件。


中心静脉导管（CVC）是儿童静脉血栓栓塞（VTE）最重要的危险因素。在发生 CVC 相关 VTE (CVC-VTE) 后，后续 CVC 置入的二级预防的作用尚不确定。这项单中心回顾性研究的目的是评估二级预防对既往患有 CVC-VTE 的患者的疗效，并确定 2003 年至 2013 年间有 CVC-VTE 指数的 19 岁以下患者中与复发 VTE 相关的危险因素。 数据收集内容包括临床和人口统计学因素、随后的 CVC 放置、二级预防策略、复发性 VTE 和出血。使用生存和二项式模型评估复发的危险因素和二级预防的有效性。在 373 名有 CVC-VTE 指数的患者中，239 名（64.1%）随后进行了 CVC 植入； 17.4% (65/373) 的患者有复发性 VTE，其中 90.8% (59/65) 与 CVC 相关。在多变量生存分析中，每增加一个 CVC（风险比 [HR] 12.00；95% 置信区间 [CI] 2.78-51.91）、先天性心脏病（HR 3.70；95% CI 1.97-6.95）和完全肠外营养依赖（HR 3.70；95% CI 1.97-6.95） 4.02；95% CI 2.23-7.28）与复发风险增加相关。用于二级预防的全剂量抗凝与 CVC-VTE 复发几率降低相关（比值比 [OR] 0.35；95% CI 0.19-0.65），但与预防剂量无关（OR 0.61；95% CI 0.28-1.30）。只有 1.3% 的 CVC 在预防性或全剂量抗凝治疗后出现大出血。总之，患有 CVC-VTE 的儿童复发 VTE 的风险增加。使用全剂量抗凝进行二级预防可使血栓事件的发生率降低 65%。