Abstract
The presence of a central venous catheter and admission to the intensive care unit
are the most important risk factors for deep venous thrombosis (DVT) in children.
At least 18% of critically ill children with a catheter develop radiologically confirmed
catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically
ill children with a catheter and is associated with 8 additional days of mechanical
ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically
ill children with catheter-associated thrombosis develop postthrombotic syndrome.
Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in
critically ill children, but nearly all thrombi have developed by 4 days after insertion.
Hypercoagulability during or immediately after insertion of the catheter plays an
essential role in the development of thrombosis. Pharmacologic prophylaxis, including
local anticoagulation with heparin-bonded catheter, has not been shown to reduce the
risk of catheter-related thrombosis in children. Systemic anticoagulation in critically
ill children started soon after the insertion of the catheter, however, may be beneficial.
A multicenter clinical trial that is testing this hypothesis is currently underway.
Keywords
clinical trial - intensive care unit - pulmonary embolism - postthrombotic syndrome
- prophylaxis
