Prophylactic anticoagulation decreases catheter-related thrombosis and occlusion in children with home parenteral nutrition

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 36; no. 4; p. 456
• Main Authors: Vegting, I L, Tabbers, M M, Benninga, M A, Wilde, J C, Serlie, M J, Tas, T A, Jonkers, C F, van Ommen, C H
• Format: Journal Article
• Language: English
• Published: United States 01.07.2012
• Subjects: Adolescent; Blood Coagulation - drug effects; Catheterization, Central Venous - methods; Catheters - adverse effects; Child; Child, Preschool; Drug Evaluation; Female; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Infant; Male; Parenteral Nutrition, Home - methods; Retrospective Studies; Thrombosis - drug therapy; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome; Vitamin K - antagonists & inhibitors; Vitamin K - therapeutic use
• ISSN: 0148-6071
• DOI: 10.1177/0148607111416482

Home parenteral nutrition (PN) has improved the survival of children with intestinal failure. Important complications include catheter-related thrombosis, occlusion, and infection. This study evaluated the efficacy and safety of prophylactic anticoagulation in the prevention of these complications. Medical records were retrospectively reviewed of all children (0-18 years) with PN between January 1994 and March 2007 in 1 tertiary center. After introduction of prophylactic low molecular weight heparin or vitamin K antagonists in March 2007, all patients were prospectively followed until March 2010. In sum, 14 patients did not receive prophylaxis; 13 switched from no prophylaxis to prophylaxis in March 2007; and 5 directly received prophylaxis. Median age of PN onset was 4 months (range, 0.1-202) in the nonprophylaxis group (n = 27) and 25 (range, 2-167) in the prophylaxis group (n = 18); 16 children received low molecular weight heparin and 2, vitamin K antagonists. Catheter-related thrombosis developed in 9 patients with no prophylaxis (33%) and 1 with prophylaxis (6%) (P = .034). Cumulative 5-year thrombosis-free survival was 48% and 93% in the nonprophylaxis and prophylaxis groups, respectively (P = .047). Per 1,000 PN days, the nonprophylaxis and prophylaxis groups had 2.6 and 0.1 occlusions (P = .04) and 4.6 and 2.1 infections (P = .06), respectively. Cumulative infection-free survival after 3 years was 19% and 46% in the nonprophylaxis and prophylaxis groups, respectively (P = .03). Bleeding complications did not occur. Thromboprophylaxis significantly decreased catheter-related thrombosis and occlusion in children with PN without complications.