Can thrombophilia predict recurrent catheter-related deep vein thrombosis in children?
Can thrombophilia predict recurrent catheter-related deep vein thrombosis in children?
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DOI：
10.1182/blood-2017-10-811216
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发表时间：
2018-06-14
期刊：
影响因子：
20.3
通讯作者：
Brandao, Leonardo R.
中科院分区：
文献类型：
--
作者：
Avila, M. Laura;Amiri, Nour;Brandao, Leonardo R.
儿童发生（即首次）导管相关 DVT 后，血栓形成倾向测试在预测导管相关深静脉血栓 (DVT) 中的作用尚不清楚。本研究调查了血栓形成倾向与复发性导管相关 DVT 之间的关联。根据临床医生的判断和家属的喜好进行血栓形成倾向测试的儿童，以及客观证实的导管相关 DVT 病史均被纳入研究。放置新导管后复发的导管相关 DVT 是主要结果。血栓形成倾向分为轻微、严重或无。使用混合效应逻辑回归进行分析。共有 245 名患者插入了 1,365 根导管；其中 941 根导管是在发生导管相关 DVT 事件后放置的。 78.1% 的插入导管在其就位的至少 50% 时间内使用了抗凝剂作为治疗或预防措施。 12.7% 的患者有轻微血栓形成倾向，而 8.2% 的儿童有严重血栓形成倾向。复发事件的发生率为 0.23/100 导管日（95% 置信区间，0.19-0.28 导管日）； 34.3%（95% 置信区间，28.6%-40.0%）在发生血栓事件后需要新导管的患者至少有 1 次复发事件。出血并发症发生率为4.6/100例接受抗凝治疗的患者。插入导管时患者年龄较小以及未给予治疗或预防剂量的抗凝剂是复发事件的预测因素。相比之下，在接受测试的患者中，在随后的导管插入过程中，血栓形成倾向并不能预测复发性导管相关 DVT。我们的研究结果表明，可能没有必要进行血栓形成倾向检测来预测这些患者的复发。
The role of thrombophilia testing in predicting catheter-related deep vein thrombosis (DVT) after an incident (ie, first) catheter-related DVT in children remains unclear. The present study investigated the association between thrombophilia and recurrent catheter-related DVT. Children with thrombophilia testing, performed according to the clinician's judgment and the family's preference, and a history of objectively confirmed catheter-related DVT were included in the study. Recurrent catheter-related DVT after placement of a new catheter was the main outcome. Thrombophilia was classified as minor, major, or none. Analysis was conducted using mixed effect logistic regression. A total of 245 patients had 1,365 catheters inserted; 941 of these catheters were placed after the incident catheter-related DVT. Anticoagulants as treatment or prophylaxis were administered in 78.1% of inserted catheters for at least 50% of the time they were in place. Minor thrombophilia was found in 12.7% of patients, whereas major thrombophilia was seen in 8.2% of children. The incidence rate of recurrent events was 0.23/100 catheter-days (95% confidence interval, 0.19-0.28 catheter-days); 34.3% (95% confidence interval, 28.6%-40.0%) of patients requiring a new catheter after their incident thrombotic event had at least 1 recurrent event. The incidence proportion of bleeding complications was 4.6/100 patients receiving anticoagulation. Young age of the patient at the time of catheter insertion and lack of administration of treatment or prophylactic doses of anticoagulant were predictive of recurrent events. In contrast, thrombophilia was not predictive of recurrent catheter-related DVT during subsequent catheter insertions among tested patients. Our findings suggest that thrombophilia testing to predict recurrence in these patients may be unnecessary.