Prevalence of Symptomatic and Asymptomatic Thrombosis in Pediatric Oncology Patients With Tunneled Central Venous Catheters

Schoot, Reineke A.; Wetering, Marianne D. van de; Stijnen, Theo; Tissing, Wim J. E.; Michiels, Erna; Abbink, Floor; Raphaël, Martine F.; Heij, Hugo A.; Zwaan, Michel; Lieverst, Jan A.; Caron, Hubert; Ommen, Heleen van

doi:10.1002/pbc.26036

Cited by 25 publications

(33 citation statements)

References 24 publications

(74 reference statements)

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“…CVC is the most common risk factor for VTE in children with cancer. Reported rates of symptomatic catheter-related VTE range from 2.6 to 36.7%, and rates of asymptomatic catheter-related VTE range from 5.9 to 43% ( 25 – 27 ).…”

Section: Venous Thromboembolism In Children With Cancermentioning

confidence: 99%

Venous Thromboembolism in Children with Cancer and Blood Disorders

Ko¹,

Thornburg

2017

Front. Pediatr.

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Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations.

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Section: Venous Thromboembolism In Children With Cancermentioning

confidence: 99%

Venous Thromboembolism in Children with Cancer and Blood Disorders

Ko¹,

Thornburg

2017

Front. Pediatr.

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“…Previous studies have reported a TE incidence of between 2.1 and 16% for symptomatic events in children with cancer, and up to 40% when accounting for asymptomatic events. [7][8][9][10][11][12][13][14][15][16][17][18] Several risk factors have been proposed for TE in children with cancer. Previously described patient-specific factors include older age, higher body mass index (BMI), presence of thrombophilia and non-O blood group.…”

Section: Introductionmentioning

confidence: 99%

“…22 Published data in children are mostly limited to singlecentre, single disease retrospective studies or prospective studies consisting of children with acute lymphoblastic leukaemia (ALL). 7,8,11,[13][14][15][16][17][18][19][22][23][24][25][26][27] A large multi-institutional study that includes all paediatric cancer types is important to improve our understanding of risk factors for TE, and to have a sufficiently large sample size allowing for robust modelling and improved precision in estimates. Therefore, our objectives were to describe the incidence of thrombosis and to identify risk factors for thrombosis among Canadian cancer patients less than 15 years of age using a population-based approach.…”

Section: Introductionmentioning

confidence: 99%

Thromboembolism Incidence and Risk Factors in Children with Cancer: A Population-Based Cohort Study

et al. 2018

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There is conflicting information about the epidemiology of thromboembolism (TE) in paediatric oncology. Objectives were to describe the incidence and risk factors of TE in children with cancer. We included all children with cancer less than 15 years of age diagnosed from 2001 to 2016, treated at one of the 12 Canadian paediatric centres outside of Ontario and entered into the Cancer in Young People-Canada database. Potential risk factors for TE were evaluated using Cox proportional hazards regression stratified by haematological malignancies versus solid tumours. Factors associated with vascular access- and non-vascular access-related TE were compared using chi-square or Fisher's exact tests. Of the 7,471 children included, 283 experienced TE requiring medical intervention; cumulative incidence of TE at 5 years was 3.8 ± 0.2% and 0.36% ± 0.07% for life-threatening or fatal TE. For haematological malignancies, the following factors were associated with TE in multivariable regression: age < 1 year, 5 to 9.99 years and 10 to 14.99 years (relative to age 1-4.99 years), haematopoietic stem cell transplant (hazard ratio [HR] = 1.49, 95% confidence interval [CI], 1.00-2.32), anthracyclines (HR = 2.21, 95% CI, 1.12-4.37) and asparaginase (HR = 1.68, 95% CI, 1.15-2.44). For solid tumours, obesity (HR = 1.92, 95% CI, 1.01-3.68), surgery (HR = 2.70, 95% CI, 1.44-5.08), radiation (HR = 47.51, 95% CI, 24.01-94.01), anthracyclines (HR = 2.74, 95% CI, 1.29-5.82) and platinum agents (HR = 2.26, 95% CI, 1.19-4.28) were associated with TE. Life-threatening and fatal TEs were more common among non-vascular access TEs (14.5% vs. 3.3% = 0.001). In a population-based cohort, 4% of children with cancer developed a clinically significant TE. Accurate risk stratification tools are needed specific to malignancy type.

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“…The relatively short follow-up periods of included studies carry a risk of underestimation of the effectiveness of thromboprophylaxis (and conversely, overestimation of its safety), as TE or bleeding events could be missed both in the intervention and control groups. Yet, current evidence states that TE occurs early on following diagnosis and treatment of ALL in children, 38 leading us to believe that the majority of TE would be captured despite the short follow-up period of some studies. Third, a high degree of heterogeneity was observed among study findings suggesting inconsistencies in effect size for effectiveness of thromboprophylaxis modalities across trials for reasons that are not immediately apparent on qualitative assessment of the studies.…”

Section: Standard Of Carementioning

confidence: 99%

Effectiveness and Safety of Primary Thromboprophylaxis in Children with Cancer: A Systematic Review of the Literature and Network Meta-Analysis

et al. 2019

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Thromboembolism (TE) is a well-recognized complication of pediatric cancer and can lead to mortality and excess morbidity. There is conflicting evidence about the effectiveness and safety of thromboprophylaxis in children. We conducted a systematic literature review and network meta-analysis of primary pharmacological thromboprophylaxis in children and adolescents (0–21 years) with cancer. The primary outcomes were objectively proven TE and major bleeding. The network meta-analysis included comparisons of multiple alternatives simultaneously: antithrombin (AT) replacement, low molecular weight heparin (LMWH), vitamin K antagonists (VKAs), and standard of care (SOC) defined as no thromboprophylaxis or low-dose heparin for catheter patency. Six articles describing 1,318 patients were included (mean age: 6.7 years, 56.7% male). Acute lymphoblastic leukemia was the underlying diagnosis in 97.5% of patients. All studies were considered at moderate or high risk of bias. LMWH was the only agent associated with lower odds of TE compared with SOC (odds ratio [OR]: 0.23, 95% confidence interval [CI]: 0.06–0.81). No statistically significant difference was detected between other thromboprophylaxis modalities and SOC. Tau2 and I 2 suggested a high degree of heterogeneity. No statistically significant differences in the odds of major bleeding were found between AT replacement, LMWH, VKA, and SOC. Current evidence suggests that low-dose LMWH is effective and safe to prevent TE in children with cancer but is insufficient to conclude if AT replacement or VKA are effective thromboprophylaxis options. Further research, notably randomized controlled trials enrolling children with diverse types of cancer, is crucially needed.

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Prevalence of Symptomatic and Asymptomatic Thrombosis in Pediatric Oncology Patients With Tunneled Central Venous Catheters

Abstract: Prevalence of both symptomatic VTE and asymptomatic CVC-related VTE was low compared to other studies, which may be explained by the inclusion of patients with solid tumors, reduction of CABSI by ethanol, use of tunneled CVCs, and use of US.

Cited by 25 publications

References 24 publications

Venous Thromboembolism in Children with Cancer and Blood Disorders

Venous Thromboembolism in Children with Cancer and Blood Disorders

Thromboembolism Incidence and Risk Factors in Children with Cancer: A Population-Based Cohort Study

Effectiveness and Safety of Primary Thromboprophylaxis in Children with Cancer: A Systematic Review of the Literature and Network Meta-Analysis

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