116 - Thromboprophylaxis in Children to Prevent Central Venous Catheter Associated Thrombosis: A Systematic Review and Meta-Analysis

Poster Number: 116
Publication Number: 116.3131

Background: Central venous catheters (CVC), which are frequently used in children in both inpatient and outpatient settings, are strongly associated with increased risk of deep vein thrombosis (CADVT). It remains unclear if pharmacologic thromboprophylaxis is effective in preventing CADVT in children.

Objective: To determine the effectiveness of pharmacologic thromboprophylaxis in reducing the risk of CADVT in children.

Design/Methods: We conducted a systematic review and meta-analysis of several databases including Ovid MEDLINE, Ovid Embase and Cochrane Library from inception to July 2022. We included observational and interventional studies in which unfractionated heparin, heparin-bonded CVCs, low molecular weight heparin, vitamin K antagonists, direct thrombin inhibitors, antiplatelet agents and direct oral anticoagulants were administered. Studies were excluded if they did not include our primary outcome of radiologically confirmed deep vein thrombosis (DVT), contained data on pre-term infants or adults (>21 years) only, focused on patients requiring extracorporeal membrane oxygenation (ECMO), or reported non-human data. Patient demographics, characteristics of the CVC, name and dosing of the prophylactic agent, and radiologic method used to detect DVT were abstracted.

Results: A total of 11 studies met eligibility criteria and included 1,158 patients. Anticoagulants used in the studies included low molecular weight heparin (LMWH), utilized in seven studies; unfractionated heparin (UFH) in four studies; vitamin k antagonists in five studies; and heparin bonded catheters in one study. Catheter type varied among studies but included tunneled and non-tunneled catheters as well as peripherally-inserted and Hickman catheters. Fifteen percent (67/455) of patients who received pharmacologic thromboprophylaxis developed CADVT and 16% (113/703) of patients who did not receive pharmacologic thromboprophylaxis developed CADVT. Risk ratio of CADVT with pharmacologic thromboprophylaxis was 0.7 (95% confidence interval, 0.43-1.14, p=0.03). There was significant heterogeneity observed amongst the studies (I2 = 49%).

Conclusion(s): Pharmacologic thromboprophylaxis was not associated with reduced risk of CADVT in mixed populations of children. However, further analyses may elucidate a benefit if specific patient subgroups are analyzed individually.