Enoxaparin Reduces Catheter-associated Venous Thrombosis After Infant Cardiac Surgery

Swartz, Michael F.; Hutchinson, D. N.; Stauber, Sierra D; Taillie, Eileen; Alfieris, George M.; Cholette, Jill M.

doi:10.1016/j.athoracsur.2021.05.009

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Our findings add to the growing literature on the effectiveness of pharmacologic prophylaxis against VTE in children. Observational studies in postoperative cardiac children found associations between use of prophylactic enoxaparin and reduced risk of thrombosis (19, 20). Furthermore, the Catheter-Related Early Thromboprophylaxis with Enoxaparin (CRETE) and THROMBOTECT Trials suggested reductions in the risk of VTE in children with prophylactic enoxaparin (5, 21).…”

Section: Discussionmentioning

confidence: 99%

“…Based on these data, we hypothesize that this reduction was due to higher percentage of catheter-days on enoxaparin and increase in its starting dose. The CRETE Trial and other observational studies suggested that the standard prophylactic dose of enoxaparin may be insufficient to prevent CADVT in infants (20, 23). Among infants in our study, rates of CADVT generally decreased across periods as the starting dose of enoxaparin was increased.…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Centers

Hege

Nitu

et al. 2022

Pediatric Critical Care Medicine

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The effectiveness of pharmacologic prophylaxis against catheterassociated thrombosis in children is unclear. We evaluated the compliance and outcomes associated with a prophylactic enoxaparin protocol in postoperative cardiac children. DESIGN:The protocol was implemented as a quality improvement initiative and then analyzed using interrupted time series method. Data collected from November 2014 to December 2018 were divided into preprotocol (period 1), protocol implementation (period 2), and protocol revision (period 3). SETTING:A 12-bed academic pediatric cardiac ICU. PATIENTS:Children less than or equal to 18 years old with congenital heart disease admitted postoperatively with central venous catheter in situ for greater than or equal to 1 day. INTERVENTIONS:Before 2016, prophylactic enoxaparin was administered according to physician preference. In January 2016, an enoxaparin protocol was implemented with a goal anti-Xa range of 0.25-0.49 international units/mL. Protocol was revised in February 2017 to increase the starting dose by 25% for infants less than 1 year old. MEASUREMENTS AND MAIN RESULTS:We analyzed 780 hospitalizations from 636 children. Median percentage of catheter-days on prophylactic enoxaparin was 33% (interquartile range [IQR], 23-47%), 42% (IQR, 30-51%), and 38% (IQR, 35-52%) in periods 1-3, respectively. Percentage of catheter-days on enoxaparin showed immediate increase of 90% (95% CI, 17-210%) between periods 1 and 2 and sustained increase of 2% (95% CI, 0.3-4%) between periods 2 and 3. Median rates of thrombosis per 1,000 catheter-days were 5.8 (IQR, 0-9.3), 3.8 (IQR, 0-12), and 0 (IQR, 0-5.3) in periods 1-3, respectively. Rate of thrombosis showed immediate decrease of 67% (95% CI, 12-87%) between periods 1 and 2 and sustained decrease of 11% (95% CI, 2-18%) between periods 1 and 3. CONCLUSIONS:The temporal association between increase in percentage of catheter-days on enoxaparin and decrease in rate of thrombosis suggests the effectiveness of prophylactic enoxaparin. KEY WORDS: anticoagulation agents; central venous catheter; intensive care units; pediatric; venous thrombosis C hildren with congenital heart disease (CHD) admitted postoperatively to the cardiovascular ICU (CVICU) are at high risk of venous thromboembolism (VTE) (1, 2). Placement of central venous catheter (CVC) constitutes an important risk factor for VTE (3). Peripherally inserted central catheter (PICC)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Centers

Hege

Nitu

et al. 2022

Pediatric Critical Care Medicine

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“…Among children with CHD, Swartz et al [35 ▪ ] investigated the effectiveness of pharmacologic prophylaxis against CADVT. They gave prophylactic LMWH after infant cardiac surgery, targeting a typical therapeutic anti-Xa goal of 0.5–1 IU/ml.…”

Section: Prevention Of Central Venous Catheter-associated Deep Vein T...mentioning

confidence: 99%

Central venous catheter-associated deep vein thrombosis in critically ill pediatric patients: risk factors, prevention, and treatment

Johnson

Faustino

2022

Current Opinion in Pediatrics

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Purpose of review Central venous catheter (CVC) placement and ICU admission are the two most important risk factors for pediatric deep vein thrombosis. The optimal prevention and treatment strategies for CVC-associated deep vein thrombosis (CADVT) are unclear, but recently, seminal studies have been published. This review aims to summarize the recent literature on CADVT in critically ill children. Recent findings Recent publications focused on three themes: risk factors, prevention, and treatment of CADVT. Newly identified risk factors for CADVT relate to Virchow's triad of hemostasis, blood vessel injury, and hypercoagulability. New risk prediction models have moderately good accuracy in predicting CADVT. Though previous data on pharmacologic CADVT prophylaxis was equivocal, recent studies indicate that low-molecular-weight heparin may be effective in preventing CADVT, particularly in critically ill children. Finally, new studies suggest that direct oral anticoagulants and shorter treatment times are noninferior to traditional agents and treatment durations in the treatment of CADVT. Summary Recent research suggests new ways to accurately identify children at high risk of CADVT, effectively prevent CADVT, and optimize CADVT treatment. Future research should focus on understanding the pathobiology of CADVT formation, prevention, and treatment in critically ill children.

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Is Blood Thicker Than Water? Perhaps Not Always…

Husain¹

2022

The Annals of Thoracic Surgery

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Enoxaparin Reduces Catheter-associated Venous Thrombosis After Infant Cardiac Surgery

Cited by 3 publications

References 31 publications

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis

Central venous catheter-associated deep vein thrombosis in critically ill pediatric patients: risk factors, prevention, and treatment

Is Blood Thicker Than Water? Perhaps Not Always…

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