Promising biomarkers for the prediction of catheter‐related venous thromboembolism in hospitalized children: An exploratory study

Abstract

Background: Pediatric venous thromboembolism (VTE) has increased over the past 10 years, with central venous catheters (CVC) being the strongest risk factor. Current tools are not sufficient to predict VTE risk. The utility of biomarkers in predicting CVC-related VTE has been minimally explored. Our objective is to determine the utility of microparticles (MPs), factor VIII (FVIII) activity, and thrombin generation (TG) in prospectively predicting VTE occurrence in hospitalized children with CVCs. Procedure:In this nested case-control pilot study, consecutive hospitalized children needing CVC placement (1 month to 21 years) were enrolled. Venous samples were collected prior to or within 24 h of CVC placement. MPs were measured using factor Xa initiated clot-based assay. FVIII was measured using a one-stage clot-based assay. TG was measured using calibrated automated thrombogram.Results: There were three CVC-related VTE events (7%) in our cohort of 42 subjects. Xa clotting time (XaCT) ratio was lower (0.68 ± 0.07 vs 0.95 ± 0.21, P = .4), while FVIII (461 ± 120 vs 267 ± 130, P = .02), peak thrombin (418 ± 89 vs 211 ± 101, P = .001), endogenous thrombin potential (ETP) (1828 ± 485 vs 1282 ± 394, P = .03), and velocity index (VI) (182 ± 28 vs 75 ± 53, P = .001) were higher in subjects with CVC-related VTE compared to those without CVC-related VTE. Sensitivity/specificity analysis revealed optimal cutoff values for XaCT ratio (0.75), FVIII (370), ETP (1680), peak (315), and VI (130), with receiver operating characteristic area under the curve values >0.9.Conclusion: MPs, FVIII, and TG can potentially predict pediatric CVC-related VTE in a prospective fashion. Stratification according to VTE risk may aid in guiding preventative efforts in future studies.

Risk factors for central venous catheter-related thrombosis in hospitalized children: a single-center a retrospective cohort study

“…At present, a recognized risk assessment scale for evaluating the occurrence of CRT in children with CVCs is lacking (28) in China and abroad (38), which needs further research and development. In clinical practice, it is necessary to take appropriate layered preventive measures based on the patient's CRT risk assessment level and the characteristics of risk factors in order to reduce the burden of clinical work (39), improve clinical efficiency, and reduce the occurrence of CVC-CRT under the condition of ensuring the safety of patients. At the same time, in clinical settings, peripheral intravenous infusion channels need to be retained as much as possible based on the patient's situation so as to minimize the use of CVCs catheters and reduce the potential for developing CRT.…”

Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions

“…55 Thrombin generation has been shown to increase during the course of ECMO, 56 57 although there appear to be no publications specifically relating TGA parameters to circuit clotting. However, TGA was found to potentially predict thrombus formation on central venous catheters, 58 so its relation to oxygenator thrombosis should be investigated further.…”