Thrombolytic Instillation for Central Venous Catheter Dysfunction and Venous Thromboembolism Risk Among Critically Ill Children

Anthony A. Sochet; Minh Q. Le; Neil A. Goldenberg; Marisol Betensky

doi:10.1055/a-2734-3037

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost
DOI: 10.1055/a-2734-3037

Original Article

Thrombolytic Instillation for Central Venous Catheter Dysfunction and Venous Thromboembolism Risk Among Critically Ill Children

Authors

Anthony A. Sochet

¹Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

²Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida
Minh Q. Le

²Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida
Neil A. Goldenberg

²Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida

³Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁴Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁵Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
Marisol Betensky

²Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida

⁴Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

⁵Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida

Abstract

Central venous catheter (CVC) dysfunction is a common complication of indwelling CVCs for hospitalized children, often secondary to intraluminal thrombosis. We sought to characterize thrombolytic agent use for restoration of CVC patency and assess its association with hospital-acquired venous thromboembolism (HA-VTE). We performed a multicenter retrospective cohort study using the Pediatric Health Information Systems database, including critically ill children < 18 years of age with a CVC in 2023 at 44 participating centers. Exclusion criteria were VTE present on admission and thrombolytic agent (i.e., alteplase or urokinase) use for systemic or catheter-directed thrombolysis or adhesiolysis. The primary outcome was HA-VTE frequency, including deep venous thrombosis and pulmonary embolism, compared by cohorts with or without exposure to thrombolytic agents. In addition to comparative analyses, adjusted logistic regression was employed to assess the association between thrombolytic agent exposure and HA-VTE. Of 9,822 children, including 10,904 CVCs, the median participating center prescribing rate of thrombolytic agents was 33.8% (interquartile range, IQR: 25–43.5%), and the median HA-VTE rate was 11.9% (IQR: 9.2–15.8%). VTE events exhibited a bimodal age distribution (i.e., greatest among infants and adolescents) without variation by CVC type. In a multivariable conditional logistic model accounting for prothrombotic risk factors, severity of illness markers, and hospital center, thrombolytic agent use for CVC dysfunction was independently associated with HA-VTE (adjusted odds: 1.89; 95% confidence interval: 1.64–2.19, p < 0.001). Among critically ill children, thrombolytic agent use for CVC dysfunction was common and independently associated with HA-VTE.

Keywords

HA-VTE - CVC - thrombolysis - pediatric - tissue plasminogen activator

Full Text

References

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