Systemic Catheter-Related Venous Thromboembolism in Children: Data From the Italian Registry of Pediatric Thrombosis

Donatella Lasagni; Margherita Nosadini; Angelo Claudio Molinari; Paola Saracco; Maria Federica Pelizza; Fiammetta Piersigilli; Maria Caterina Putti; Marcella Gaffuri; Paola Giordano; Giulia Lorenzoni; Andrea Francavilla; Sandra Trapani; Matteo Luciani; Agnese Suppiej; Antonella Tufano; Daniela Tormene; Matteo Martinato; Dario Gregori; Stefano Sartori; Paolo Simioni; Systemic Thromboses Working Group of the Italian Registry of Pediatric Thrombosis (RITI Registro Italiano Trombosi Infantili)

doi:10.3389/fped.2022.843643

Systemic Catheter-Related Venous Thromboembolism in Children: Data From the Italian Registry of Pediatric Thrombosis

Front Pediatr. 2022 Mar 23:10:843643. doi: 10.3389/fped.2022.843643. eCollection 2022.

Authors

Donatella Lasagni¹, Margherita Nosadini², Angelo Claudio Molinari³, Paola Saracco⁴, Maria Federica Pelizza², Fiammetta Piersigilli⁵, Maria Caterina Putti⁶, Marcella Gaffuri⁷, Paola Giordano⁸, Giulia Lorenzoni⁹, Andrea Francavilla⁹, Sandra Trapani¹⁰, Matteo Luciani¹¹, Agnese Suppiej¹², Antonella Tufano¹³, Daniela Tormene¹⁴, Matteo Martinato⁹, Dario Gregori⁹, Stefano Sartori², Paolo Simioni¹⁴; Systemic Thromboses Working Group of the Italian Registry of Pediatric Thrombosis (RITI Registro Italiano Trombosi Infantili)

Collaborators

Systemic Thromboses Working Group of the Italian Registry of Pediatric Thrombosis (RITI Registro Italiano Trombosi Infantili):
Manuela Agostini, Bianca Bassi, Elisa Bertoni, Anna Casani, Daniela Farinasso, Elena Gallo, Chiara Gentilomo, Massimo Grassi, Fabio Lunetta, Mariella Magarotto, Francesca Maschio, Antonella Palmieri, Andrea Pettenazzo, Roberto Sangermani, Annamaria Laverda

Affiliations

¹ Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.
² Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
³ Thrombosis and Hemostasis Unit, G. Gaslini Children's Hospital, Genoa, Italy.
⁴ Pediatric Hematology, Department of Pediatrics, University Hospital Città della Salute e della Scienza, Turin, Italy.
⁵ Neonatology Unit, IRCCS Pediatric Hospital Bambin Gesù, Rome, Italy.
⁶ Department of Oncology and Hematology, University Hospital of Padua, Padua, Italy.
⁷ Pediatric Department Civile Maggiore Hospital, Verona, Italy.
⁸ Pediatric Hematology and Oncology, University of Bari, Bari, Italy.
⁹ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padua, Italy.
¹⁰ Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy.
¹¹ Department of Hematology and Oncology and Transfusional Medicine, IRCCS Pediatric Hospital Bambin Gesù, Rome, Italy.
¹² Department of Medical Sciences-Pediatric Section, University of Ferrara, Ferrara, Italy.
¹³ Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy.
¹⁴ General Internal Medicine and Thrombotic and Hemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy.

Abstract

Background: Central venous catheters (CVCs) represent one of the main risk factors for venous thrombotic events (VTEs) in children.

Methods: We studied the Italian Registry of Pediatric Thrombosis (RITI) with regard to systemic radiologically confirmed CVC-related VTEs (CVC-VTEs) occurred during 6.5 years in children aged 29 days to 18 years.

Results: A total of 78 CVC-VTEs were included, which occurred in 76 patients (40/76, 53% males). CVC-VTEs comprised 67 non-cardiac VTEs (86%) and 11 intracardiac thrombotic events (ICTEs) (14%); the median age at onset was 19 and 17 months, respectively. The most frequent reason for CVC insertion was supportive therapy. The catheters were placed percutaneously in 85% of cases (56/66) and surgically in the remaining 15% (10/66). Peripherally inserted central catheters (PICCs) were used in 47% (31/66) cases, partially implanted catheters in 42% (28/66), non-implantable catheters in 7% (5/66), and totally implanted catheters (Port) in 2% (1/66). CVC-VTEs were symptomatic in 77% of cases (60/78), while in the remaining 23%, they were incidentally detected on the imaging performed for the underlying condition. The median time between CVC insertion and the onset of symptoms was 10 days in non-cardiac VTEs and 39 days in ICTEs. Doppler ultrasound was the diagnostic technique most frequently used. The venous compartment most frequently affected was the veins of the lower extremities (52%, 43/73). Anti-thrombotic treatment was administered in 96% of CVC-VTEs (75/78). About 2.6% (2/76) of patients experienced a second thrombotic event. At discharge, post-thrombotic syndrome was reported in 13.5% (5/37) events with available data, CVC replacement in 10.8% (4/47), and ischemic necrosis with toe finger amputation in 2.7% (1/37). Three patients died due to an underlying condition; no CVC-VTE-related deaths were reported.

Conclusions: We have carried out a registry-based study on CVC-VTEs in the children in Italy, providing the data that may help improve the detection and management of this CVC-related complication.

Keywords: catheter-complications; central venous catheter (CVC); children; heparin; pediatric; registry; thrombosis.

Copyright © 2022 Lasagni, Nosadini, Molinari, Saracco, Pelizza, Piersigilli, Putti, Gaffuri, Giordano, Lorenzoni, Francavilla, Trapani, Luciani, Suppiej, Tufano, Tormene, Martinato, Gregori, Sartori, Simioni and The Systemic Thromboses Working Group of the Italian Registry of Pediatric Thrombosis (RITI Registro Italiano Trombosi Infantili).