Prophylactic Anticoagulation Decreases Catheter‐Related Thrombosis and Occlusion in Children With Home Parenteral Nutrition

Vegting, I.L.; Tabbers, Merit M.; Benninga, Marc A.; Wilde, Jim C. H.; Serlie, Mireille J.; Tas, T. A. J.; Jonkers, C.; Ommen, C. Heleen van

doi:10.1177/0148607111416482

Cited by 38 publications

(38 citation statements)

References 23 publications

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“…Schoot et al [112] reviewed three randomized controlled trials and three controlled clinical trials of systemic treatment (low molecular weight heparin, antithrombin supplementation or low dose warfarin) and found no significant effects compared with no intervention in preventing venous thromboembolic events in pediatric cancer patients with tunneled CVC, and no differences in adverse events. In an investigation of the role of prophylactic anticoagulation in children receiving home PN, Vegting et al [113] compared outcomes with retrospective data from a time when their patients did not receive this treatment. Sixteen children received low molecular weight heparin (nadoparin) and two vitamin K antagonists.…”

Section: Interventions To Decrease Thrombotic Complications and Cvc Omentioning

confidence: 99%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Braegger¹,

Bronský²,

Cai³

et al. 2018

Clinical Nutrition

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Section: Interventions To Decrease Thrombotic Complications and Cvc Omentioning

confidence: 99%

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Braegger¹,

Bronský²,

Cai³

et al. 2018

Clinical Nutrition

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“…41 There is, therefore, no evidence to support the routine use of chemical TP in children with indwelling CVCs, although VKA therapy may be useful in children requiring long-term central venous access for the administration of TPN. 12,23,42 Evidence for the efficacy of chemical TP in adolescents and children with trauma is limited. A study of 260,078 pediatric trauma patients between 2001 and 2008 showed that prescriptions of enoxaparin for TP doubled over the studied time period but without a change in the incidence of VTE, which remained at around 0.25%.…”

Section: Chemical Thromboprophylaxismentioning

confidence: 99%

Venous Thromboembolism in Children: Is It Preventable?

Biss

2016

Semin Thromb Hemost

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The incidence of venous thromboembolism (VTE) in children is increasing. Hospitalized infants and adolescents are at highest risk, and most individuals who have VTE have multiple thrombotic risk factors. The presence of a central venous catheter (CVC) is the most frequent risk factor for childhood thrombosis. Childhood VTE has significant consequences in relation to the thrombotic event and the anticoagulant therapy used for its treatment. Identification of the most prevalent risk factors for VTE, particularly among adolescents, has moved the focus toward prevention of thrombosis. Risk assessment models have been developed to identify individuals who are at higher risk with a view to employing preventative strategies such as mechanical and chemical thromboprophylaxis (TP). There is currently little evidence to support the efficacy of such strategies for preventing either CVC-associated thrombosis or thrombosis at other sites. In addition, there are concerns about adverse consequences of mechanical and chemical TP in a population where the overall incidence of VTE remains low.

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“…From a clinical point of view, our data make it unlikely that platelet aggregation is involved in catheter-related thrombosis during parenteral nutrition [23]. Anticoagulation rather than platelet aggregation inhibitors may, therefore, be useful to prevent catheter-related thrombosis [32].…”

Section: Discussionmentioning

confidence: 87%

Influence of parenteral nutrition on blood rheology and platelet aggregation in vitro

et al. 2014

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BACKGROUND: Parenteral nutrition (PN) is a hyperosmolar solution composed of glucose, amino acids and a lipid emulsion, which is often used despite well-known side effects and complications. OBJECTIVES: In this study the hypothesis was tested that PN could affect hemorheology. METHODS: The influence of increasing plasma concentrations (0, 4, 10 and 25%) of the 3-in-1-mixture of PN on various rheological parameters were studied in vitro. The influence of the individual components was studied with plasma concentrations of 10, 10 and 5%, respectively. Hematological and coagulation tests were performed. Blood viscosity and red blood cell (RBC) aggregation were measured and platelet aggregation in flowing blood was assessed with a PFA-100 instrument. RESULTS: It was found that PN induced RBC shrinkage, which was partially reversible. It reduced RBC aggregation measured by low shear viscosity or RBC sedimentation. Platelet aggregation was strongly inhibited. Coagulation tests were not affected. Investigations with the single components of PN showed that the RBC shrinkage was mainly caused by the amino acid solution and the inhibition of platelet aggregation by all 3 components. The lipid emulsion in higher plasma concentrations led to echinocytosis, indicating that the lipids interact with the outer half of the membrane lipid bilayer. CONCLUSIONS: High concentrations of PN affect blood rheology in several ways. The strongest effect was an inhibition of platelet aggregation, which may have a clinical relevance. Other effects such as RBC shrinkage and decreased RBC aggregation occurred only at high PN concentrations, which are reached in vivo at the infusion site.

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Prophylactic Anticoagulation Decreases Catheter‐Related Thrombosis and Occlusion in Children With Home Parenteral Nutrition

Abstract: Thromboprophylaxis significantly decreased catheter-related thrombosis and occlusion in children with PN without complications.

Cited by 38 publications

References 23 publications

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access

Venous Thromboembolism in Children: Is It Preventable?

Influence of parenteral nutrition on blood rheology and platelet aggregation in vitro

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