Rate of thrombosis in children and adolescents hospitalized with COVID-19 or MIS-C

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with thrombotic complications in adults, but the incidence of COVID-19 related thrombosis in children and adolescents is unclear. Most children with acute COVID-19 have mild disease, but coagulopathy has been associated with multisystem inflammatory syndrome in children (MIS-C), a post-infectious complication. We conducted a multicenter retrospective cohort study to determine the incidence of thrombosis in children hospitalized with COVID-19 or MIS-C and to evaluate associated risk factors. We classified patients into one of three groups for analysis: COVID-19, MIS-C, or asymptomatic SARS-CoV-2. Among a total of 853 admissions (426 COVID-19, 138 MIS-C, and 289 asymptomatic SARS-CoV-2) in 814 patients, there were 20 patients with thrombotic events (TE) (including 1 stroke). Patients with MIS-C had the highest incidence (6.5%, 9/138) versus COVID-19 (2.1%, 9/426) or asymptomatic SARS-CoV-2 (0.7%, 2/289). In patients with COVID-19 or MIS-C, the majority of thrombotic events (89%) occurred in patients ≥12 years. Patients > 12 years with MIS-C had the highest rate of thrombosis at 19% (9/48). Notably, 71% of TE that were not present on admission occurred despite thromboprophylaxis. Multivariable analysis identified the following as significantly associated with thrombosis: age ≥12 years, cancer, presence of a central venous catheter, and MIS-C. In patients with COVID-19 or MIS-C, hospital mortality was 2.3% (13/564), but was 28% (5/18) in patients with thrombotic events. Our findings may help inform pediatric thromboprophylaxis strategies.

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Risk factors for central venous catheter thrombotic complications in children and adolescents with cancer

Cancer ◽

10.1002/cncr.25199 ◽

2010 ◽

Vol 116 (17) ◽

pp. 4197-4205 ◽

Cited By ~ 73

Author(s):

S. Revel-Vilk ◽

J. Yacobovich ◽

H. Tamary ◽

G. Goldstein ◽

S. Nemet ◽

...

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Children And Adolescents ◽

Venous Catheter ◽

Central Venous ◽

Thrombotic Complications

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COVID-19-associated multisystem inflammatory syndrome in children presenting uniquely with sinus node dysfunction in the setting of shock

Cardiology in the Young ◽

10.1017/s1047951121000354 ◽

2021 ◽

pp. 1-3

Author(s):

Lesya G. Tomlinson ◽

Mitchell I. Cohen ◽

Rebecca E. Levorson ◽

Megan B. Tzeng

Keyword(s):

Inflammatory Process ◽

Myocardial Dysfunction ◽

Sinus Node ◽

Qtc Prolongation ◽

Mild Disease ◽

Abnormal Immune Response ◽

Idioventricular Rhythm ◽

Inflammatory Syndrome ◽

Electrocardiographic Abnormalities ◽

Post Infectious

Abstract SARS-CoV-2, which causes the disease COVID-19, generally has a mild disease course in children. However, a severe post-infectious inflammatory process known as multisystem inflammatory syndrome in children has been observed in association with COVID-19. This inflammatory process is a result of an abnormal immune response with similar clinical features to Kawasaki disease. It is well established that multisystem inflammatory syndrome in children is associated with myocardial dysfunction, coronary artery dilation or aneurysms, and occasionally arrhythmias. The most common electrocardiographic abnormalities seen include premature atrial or ventricular ectopy, variable degrees of atrioventricular block, and QTc prolongation, and rarely, haemodynamically significant arrhythmias necessitating extracorporeal membrane oxygenation support. However, presentation with fever, hypotension, and relative bradycardia with a left axis idioventricular rhythm has not been previously reported. We present a case of a young adolescent with multisystem inflammatory syndrome in children with myocarditis and a profoundly inappropriate sinus node response to shock with complete resolution following intravenous immunoglobulin.

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Successful removal of a central venous catheter misplaced in the right subclavian artery using an intravascular stent: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00418-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Haruka Yoshida ◽

Shinichiro Ikemoto ◽

Yasuyuki Tokinaga ◽

Kanako Ejiri ◽

Tomoyuki Kawamata

Keyword(s):

Central Venous Catheter ◽

Subclavian Artery ◽

Axillary Artery ◽

Insertion Site ◽

Venous Catheter ◽

Central Venous ◽

Thrombotic Complications ◽

Successful Removal ◽

Intravascular Stent ◽

The Right

Abstract Background Cannulation of a central venous catheter is sometimes associated with serious complications. When arterial cannulation occurs, attention must be given to removal of a catheter. Case presentation A 62-year-old man was planned for emergency thoracic endovascular aortic repair. After the induction of anesthesia, a central venous catheter was unintentionally inserted into the right subclavian artery. We planned to remove the catheter. Since we considered that surgical repair would be highly invasive for the patient, we decided to remove it using a percutaneous intravascular stent. A stent was inserted through the right axillary artery. The stent was expanded immediately after the catheter was removed. Post-procedural angiography revealed no leakage from the catheter insertion site and no occlusion of the right subclavian and vertebral arteries. There were no obvious hematoma or thrombotic complications. Conclusions A catheter that has been misplaced into the right subclavian artery was safely removed using an intravascular stent.

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Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

The Journal of Vascular Access ◽

10.1177/1129729820944066 ◽

2020 ◽

pp. 112972982094406

Author(s):

Lucio Brugioni ◽

Elisabetta Bertellini ◽

Mirco Ravazzini ◽

Marco Barchetti ◽

Andrea Borsatti ◽

...

Keyword(s):

Central Venous Catheter ◽

Guide Wire ◽

Case Series ◽

Venous Catheter ◽

Venous Access ◽

Late Complications ◽

Central Catheter ◽

Central Venous ◽

Single Lumen ◽

Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

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Unfractionated Heparin (UFH) For Prevention of Central Venous Catheter Thrombotic Complications in Children: A systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcab113.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Marwa W Nasef ◽

Maha M El-gaffary ◽

Mervet G Mansour ◽

Esraa S Abd El Aty

Keyword(s):

Central Venous Catheter ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Meta Analysis ◽

Venous Catheter ◽

Controlled Trials ◽

Central Venous ◽

Thrombotic Occlusion ◽

Thrombotic Complications

Abstract Objective To determine the efficacy of unfractionated heparin in reducing central venous catheter-related deep venous thrombosis and/or catheter thrombotic occlusion in children by systematically searching the literature and conducting a meta-analysis study. Methods Four electronic databases (PubMed, Google Scholar, Elsevier’s thrombosis journal, and the Cochrane Central Register for Controlled Trials) were searched for journal peer-reviewed articles published in the period from Jan 2000 to Dec 2018. The search criteria included observational studies, and randomized controlled trials on patients aged 0–18 years with central venous catheters (CVC), which compare between the effect of UFH (flushes, lock solutions, continuous infusion, and heparin bonded catheter) and no prophylaxis (Normal saline flush or no treatment) for the prevention of CVC thrombotic complications (CVC-related deep venous thrombosis (DVT) and/or catheter thrombotic occlusion). Two authors independently reviewed and identified the eligible studies, which were assessed for study methodology including bias, and extraction of unadjusted data whenever available. To pool data from eligible studies, the meta-analysis was performed on RevMan version 5.3. Odds ratios were generated with the corresponding 95% CI through the random-effect model. Results Of the 413 articles identified, only eight studies were eligible with 1380 patients. Our results revealed that UFH was significantly superior on control group in reducing thrombotic occlusion and/or CVC-related DVT (odds ratio 0.39, 95% CI: 0.19:0.8) (p 0.01). Conclusion The published data support the hypothesis that using UFH as a thromboprophylaxis may significantly reduce catheter thrombotic complication in pediatric patients with CVC.

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Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽

10.1542/peds.2020-042069 ◽

2021 ◽

Author(s):

William J.H. Ford ◽

David G. Bundy ◽

Suzette Oyeku ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Risk Factors ◽

Pediatric Patients ◽

Secondary Analysis ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Line ◽

Type Number ◽

Central Venous ◽

Medical Centers ◽

Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients <22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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Thrombotic complications in patients with hereditary bleeding disorders

Thrombosis and Haemostasis ◽

10.1160/th04-03-0148 ◽

2004 ◽

Vol 92 (08) ◽

pp. 298-304 ◽

Cited By ~ 46

Author(s):

Massimo Franchini

Keyword(s):

Risk Factors ◽

Gene Mutations ◽

Coagulation Factor ◽

Venous Catheter ◽

Bleeding Tendency ◽

Bleeding Disorders ◽

Central Venous ◽

Prothrombotic Risk Factors ◽

Thrombotic Complications ◽

Factor Concentrate

SummaryThromboses in patients with hereditary bleeding disorders are uncommon. However, in some cases, the co-existence of prothrombotic risk factors may increase the likelihood of developing thrombotic complications in such patients. This review summarizes the cases of thrombosis reported in the literature and analyzes the most important risk factors for thrombosis in patients with a congenital bleeding tendency. In particular we focus on central venous catheter (CVC)-associated thrombosis, on the thrombotic complications of coagulation factor concentrate therapy and on the presence of prothrom-botic gene mutations. Data were identified by searches of the published literature, including PubMed, references from reviews and abstracts from the most important meetings on this topic. In conclusion, there is increasing evidence that thrombotic complications in patients with hereditary bleeding disorders have a multifactorial pathogenesis, depending on exogenous (coagulation factor replacement therapy, CVC, HIV infection) and/or endogenous (prothrombotic gene mutations) risk factors.

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Precurved non-tunnelled catheters for haemodialysis are comparable in terms of infections and malfunction as compared to tunnelled catheters: A retrospective cohort study

The Journal of Vascular Access ◽

10.1177/1129729818805954 ◽

2018 ◽

Vol 20 (3) ◽

pp. 307-312 ◽

Cited By ~ 2

Author(s):

Mathijs van Oevelen ◽

Alferso C Abrahams ◽

Marcel C Weijmer ◽

Tjerko Nagtegaal ◽

Friedo W Dekker ◽

...

Keyword(s):

Cohort Study ◽

Central Venous Catheter ◽

Confidence Interval ◽

Primary Endpoint ◽

Multivariable Analysis ◽

Venous Catheter ◽

Central Venous Catheters ◽

Hazard Ratio ◽

Central Venous ◽

Catheter Malfunction

Background: The main limitations of central venous catheters for haemodialysis access are infections and catheter malfunction. Our objective was to assess whether precurved non-tunnelled central venous catheters are comparable to tunnelled central venous catheters in terms of infection and catheter malfunction and to assess whether precurved non-tunnelled catheters are superior to straight catheters. Materials and methods: In this retrospective, observational cohort study, adult patients in whom a central venous catheter for haemodialysis was inserted between 2012 and 2016 were included. The primary endpoint was a combined endpoint consisting of the first occurrence of either an infection or catheter malfunction. The secondary endpoint was a combined endpoint of the removal of the central venous catheter due to either an infection or a catheter malfunction. Using multivariable analysis, cause-specific hazard ratios for endpoints were calculated for tunnelled catheter versus precurved non-tunnelled catheter, tunnelled catheter versus non-tunnelled catheter, and precurved versus straight non-tunnelled catheter. Results: A total of 1603 patients were included. No difference in reaching the primary endpoint was seen between tunnelled catheters, compared to precurved non-tunnelled catheters (hazard ratio, 0.91; 95% confidence interval, 0.70–1.19, p = 0.48). Tunnelled catheters were removed less often, compared to precurved non-tunnelled catheters (hazard ratio, 0.65; 95% confidence interval, 0.46–0.93; p = 0.02). A trend for less infections and catheter malfunctions was seen in precurved jugular non-tunnelled catheters compared to straight non-tunnelled catheters (hazard ratio, 0.60; 95% confidence interval, 0.24–1.50; p = 0.28) and were removed less often (hazard ratio, 0.41; 95% confidence interval, 0.18–0.93; p = 0.03). Conclusion: Tunnelled central venous catheters and precurved non-tunnelled central venous catheters showed no difference in reaching the combined endpoint of catheter-related infections and catheter malfunction. Tunnelled catheters get removed less often because of infection/malfunction than precurved non-tunnelled catheters.

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Central venous catheter–related thrombosis

Hematology ◽

10.1182/asheducation-2014.1.306 ◽

2014 ◽

Vol 2014 (1) ◽

pp. 306-311 ◽

Cited By ~ 60

Author(s):

William Geerts

Keyword(s):

Venous Catheter ◽

Central Venous ◽

Patients With Cancer ◽

Central Venous Stenosis ◽

Thrombosis Risk ◽

Increased Risk ◽

Thrombotic Complications ◽

Continued Use ◽

Catheter Related Thrombosis

Abstract Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs.

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Management of Hereditary Hypercoagulable Disorders

Hematology ◽

10.1182/asheducation-2006.1.444 ◽

2006 ◽

Vol 2006 (1) ◽

pp. 444-449 ◽

Cited By ~ 5

Author(s):

Paula L. Bockenstedt

Keyword(s):

Venous Thromboembolism ◽

Venous Catheter ◽

Dialysis Access ◽

Benefit Analysis ◽

Central Venous ◽

Hereditary Factors ◽

Thrombophilia Screening ◽

Thrombotic Complications ◽

Risk Benefit Analysis

Abstract The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome.

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