Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study

Clay T Cohen; Viia Anderson; Sudhen B Desai; Athis Arunachalam; Mubbasheer Ahmed; Rosa Diaz

doi:10.1016/j.jpeds.2020.12.061

Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study

J Pediatr. 2021 Apr:231:215-222. doi: 10.1016/j.jpeds.2020.12.061. Epub 2020 Dec 24.

Authors

Clay T Cohen¹, Viia Anderson¹, Sudhen B Desai², Athis Arunachalam³, Mubbasheer Ahmed⁴, Rosa Diaz¹

Affiliations

¹ Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX.
² Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
³ Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
⁴ Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.

PMID: 33359630
DOI: 10.1016/j.jpeds.2020.12.061

Abstract

Objective: To describe the clinical characteristics, outcomes, and adverse events of treatment for symptomatic infant catheter-related arterial thrombosis.

Study design: Single-center retrospective medical record review of 99 infants (age <365 days) with catheter-related arterial thrombosis, either following indwelling arterial catheter placement or cardiac catheterization, who were treated with anticoagulation over an 8-year span at a pediatric tertiary care center. Outcomes measured include thrombosis progression, bleeding events, and thrombus resolution following the treatment period.

Results: Thromboses were secondary to indwelling arterial catheter placement in 51 (51.5%) and cardiac catheterization in 48 (48.5%). The median age at diagnosis of catheter-related arterial thrombosis was 52 days. All patients received therapeutic anticoagulation with either unfractionated heparin or low molecular weight heparin for a maximum of 28 days. Progression of catheter-related arterial thrombosis occurred in 8 (8.1%) patients. One (1%) major and 3 (3%) minor bleeding events occurred within the cohort. Complete thrombus resolution was observed in 60 (60.6%), partial resolution in 33 (33.3%), and no resolution in 6 (6.1%) following the treatment period. Factors associated with complete thrombus resolution included time from intervention to catheter-related arterial thrombosis diagnosis (median of 1 day vs 5 days in those who experienced thrombus resolution vs those who did not, P = .035), and iliac and/or femoral artery involvement (P = .015).

Conclusions: Our treatment approach to infant catheter-related arterial thrombosis is safe and effective. Limitations of the study are its retrospective nature with a limited number of patients from a single institution. Additional prospective studies are needed to determine the optimal treatment approach to catheter-related arterial thrombosis in infants.

Keywords: anticoagulation; arterial catheter; cardiac catheterization; congenital heart disease.

MeSH terms

Anticoagulants / therapeutic use*
Cardiac Catheterization / adverse effects*
Catheters, Indwelling / adverse effects*
Cohort Studies
Female
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Thrombosis / diagnosis*
Thrombosis / drug therapy*
Thrombosis / etiology
Treatment Outcome

Substances

Anticoagulants