Secondary Anticoagulation Prophylaxis for Catheter-Related Thrombosis in Pediatric Intestinal Failure: Comparison of Short- Vs Long-Term Treatment Protocols.
Secondary Anticoagulation Prophylaxis for Catheter-Related Thrombosis in Pediatric Intestinal Failure: Comparison of Short- Vs Long-Term Treatment Protocols.
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DOI：
10.1002/jpen.2055
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Avitzur Y
中科院分区：
文献类型：
--
作者：
Schmidt ML;Wendel D;Horslen SP;Lane ER;Brandão LR;Gottschalk E;Belza C;Courtney-Martin G;Wales PW;Avitzur Y
导管相关性血栓形成（CRT）是肠功能衰竭（IF）患儿中心静脉导管的严重并发症，但CRT的最佳预防治疗尚不清楚。本研究评估了2种低分子量肝素（LMWH）二级抗凝预防方案的有效性和安全性。这是一项比较性队列研究，研究对象为来自2个IF项目的儿童，这些儿童接受了LMWH二级抗凝预防治疗。短期方案组（N = 13）接受治疗性给药，直至血栓消退或≤3个月。在长期方案组（N = 26）中，预防性给药持续至管路移除。患者每年接受常规血管超声检查，并随访≥ 1年。主要结局是继发性血栓形成;事后分析评估了12个月时继发性血栓形成的发生率。两组之间的患者人口统计学特征相似。短期方案组13例患者中有8例（62%）发生继发性血栓形成，长期方案组26例患者中有9例（35%）发生继发性血栓形成（P = .019），中位时间分别为144.5天和689天（P = .01）。13名患者中有7名（54%，短期）和26名患者中有2名（8%，长期）在12个月内发生了二次血栓形成（P = .001）。继发性血栓形成与导管更换（23.5 vs 5.5导管/1000导管日; P = 0.016）和每日肠外营养（PN）输注时间更长（24 vs 15.25小时; P = 0.044）相关。92%的患者依从性良好（>80%的剂量）。LMWH长期二级抗凝预防可降低继发性血栓形成的发生率，在需要长期PN的CRT儿童中应考虑使用LMWH。
Catheter-related thrombosis (CRT) is a devastating complication of central venous catheters in children with intestinal failure (IF), but the optimal preventive therapy of CRT is unknown. This study assessed the efficacy and safety of 2 protocols of secondary anticoagulation prophylaxis with low-molecular-weight heparin (LMWH). This is a comparative cohort study of children from 2 IF programs who received secondary anticoagulation prophylaxis with LMWH for CRT. The short-term protocol group (N = 13) received therapeutic dosing until thrombus resolution or ≤3 months. In the long-term protocol group (N = 26), prophylactic dosing continued until line removal. Patients underwent routine annual vascular ultrasound and were followed for ≥ 1 year. The primary outcome was development of secondary thrombosis; post hoc analysis assessed rates of secondary thrombosis at 12 months. Patient demographics were similar between groups. Secondary thrombosis occurred in 8 of 13 (62%) patients in the short-term group and in 9 of 26 (35%) in the long-term protocol group (P = .019) in a median time of 144.5 and 689 days, respectively (P = .01). Secondary thrombosis within 12 months occurred in 7 of 13 (54%, short term) and 2 of 26 (8%, long term) patients (P = .001). Secondary thrombosis was associated with catheter replacements (23.5 vs 5.5 catheters per 1000 catheter days; P = .016) and longer daily parenteral nutrition (PN) infusion (24 vs 15.25 hours; P = .044). Compliance was good (>80% of doses) in 92% of patients. Long-term secondary anticoagulation prophylaxis with LMWH reduces the incidence of secondary thrombosis and should be considered in children with CRT that require PN for prolonged periods of time.
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影响因子：
6.2
作者：
Kaufman SS;Avitzur Y;Beath SV;Ceulemans LJ;Gondolesi GE;Mazariegos GV;Pironi L
通讯作者：
Pironi L
影响因子：
1.7
作者：
Fullerton, Brenna S.;Hong, Charles R.;Jaksic, Tom
通讯作者：
Jaksic, Tom
DOI：
10.5223/pghn.2016.19.1.44
发表时间：
2016-03
期刊：
Pediatric gastroenterology, hepatology & nutrition
影响因子：
--
作者：
Choi SJ;Lee KJ;Choi JS;Yang HR;Moon JS;Chang JY;Ko JS
通讯作者：
Ko JS
影响因子：
20.3
作者：
Avila, M. Laura;Amiri, Nour;Brandao, Leonardo R.
通讯作者：
Brandao, Leonardo R.
影响因子：
6.7
作者：
Mitchell, L;Andrew, M;Mikulis, D
通讯作者：
Mikulis, D