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Semin Thromb Hemost 2026; 52(02): 248-255
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

    1   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
    2   Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, United States

  • Minh Q. Le

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

  • Neil A. Goldenberg

    2   Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, United States
    3   Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
    4   Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
    5   Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States

  • Marisol Betensky

    2   Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, United States
    4   Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
    5   Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
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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

Supplementary Material



Publication History

Received: 04 September 2025

Accepted: 29 October 2025

Accepted Manuscript online:
30 October 2025

Article published online:
10 November 2025

© 2025. Thieme. All rights reserved.

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