Low molecular weight heparin for prevention of central venous catheterization-related thrombosis in children

Brandão, Leonardo R.; Shah, Niketa C.; Shah, Prakeshkumar S

doi:10.1002/14651858.cd005982.pub2

Cited by 15 publications

(7 citation statements)

References 37 publications

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“…There were only 18 RCTs in pediatrics, 20 RCTs in neonates, and 3 in combined adults and pediatrics, compared to 119 adult RCTs. Previous systematic reviews have concluded that more evidence from this population group is required to reach significant results in meta-analysis [ 215 , 216 ]. Neonatal and pediatric populations have different underlying anatomy and physiology and indications for CVAD insertion and use.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trials in central vascular access devices: A scoping review

et al. 2017

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BackgroundRandomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities.MethodA scoping review (January 2006–December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form.ResultsIn total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections.ConclusionMore high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trials in central vascular access devices: A scoping review

et al. 2017

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“…Risk factors for CVC occlusion should be considered in an attempt to reduce the risk of occlusion . The use of anticoagulation and/or heparin‐bonded catheters to prevent CVC‐related thrombotic complications has not yet been proven to be effective . Whether prevention of CVC occlusion and/or prompt therapy of such occlusion can reduce the incidence of asymptomatic DVT needs further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Post‐thrombotic syndrome after central venous catheter removal in childhood cancer survivors: A prospective cohort study

Polen

Weintraub

Stoffer

et al. 2014

Pediatric Blood & Cancer

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PTS post-CVC removal in pediatric cancer survivors is not a rare event. The association between PTS and the history of CVC occlusion confirms earlier findings, and suggests that CVC occlusion may indicate asymptomatic DVT. PTS is also associated with lower HRQoL scores highlighting the need to study preventive measures, especially for high risk groups. Pediatr Blood Cancer 2015;62:285-290. © 2014 Wiley Periodicals, Inc.

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“…Despite these findings, routine primary thromboprophylaxis in pediatric cancer patients is not widespread, with various randomized controlled trials (RCTs) and controlled clinical trials (CCTs) failing to demonstrate a reduction in the incidence of both central venous catheter (CVC)‐associated VTE and systemic VTE. In addition, two Cochrane reviews concluded that no study has demonstrated a significant benefit from systemic prophylaxis for the prevention of VTE in pediatric cancer patients. Unfortunately, most of the available studies were limited by small sample sizes and were too underpowered to answer the question of efficacy.…”

Section: Selection Of Patientsmentioning

confidence: 99%

“…The risk appears to be independent of pediatric cancer type and was significantly increased (6.4 times higher) in pediatric cancer patients who developed CVC occlusion and infection . Despite this increased risk, pharmacological thromboprophylaxis does not appear to reduce the incidence of CVC‐associated VTE . Furthermore, the role that individual risk factors (such as obesity or age) may play in increasing the risk of CVC‐related thrombosis versus non‐CVC‐related thrombosis is currently unknown.…”

Section: Selection Of Patientsmentioning

confidence: 99%

The identification of at‐risk patients and prevention of venous thromboembolism in pediatric cancer: guidance from the SSC of the ISTH

Tullius

Athale

Ommen

et al. 2018

Journal of Thrombosis and Haemostasis

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Low molecular weight heparin for prevention of central venous catheterization-related thrombosis in children

Cited by 15 publications

References 37 publications

Randomized controlled trials in central vascular access devices: A scoping review

Randomized controlled trials in central vascular access devices: A scoping review

Post‐thrombotic syndrome after central venous catheter removal in childhood cancer survivors: A prospective cohort study

The identification of at‐risk patients and prevention of venous thromboembolism in pediatric cancer: guidance from the SSC of the ISTH

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