Pediatric Hematology/Oncology Unit, Department of Woman-Mother-Child, University Hospital CHUV, Lausanne, Switzerland.
Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine and Johns Hopkins All Children's Hospital and All Children's Research Institute, St. Petersburg, Florida, United States.
Thromb Haemost. 2018 Jun;118(6):1058-1066. doi: 10.1055/s-0038-1642635. Epub 2018 Apr 25.
Catheter-related arterial thrombosis (CAT) is increasingly recognized in children. Available data are scarce and based on expert opinions. This systematic review aimed to identify knowledge on paediatric CAT. Among 3,484 publications, 22 met inclusion criteria. Fourteen reported on CAT due to umbilical arterial catheter (UAC), two to extremity indwelling catheter (EIC), one to both and five to cardiac catheter (CC). The overall cumulative incidence of CAT was 21% (95% confidence interval [CI], 13-31) with a relative incidence of 20% (95% CI, 10-33) for UAC and 11% (95% CI, 3-21) for CC-related CAT. The incidence of EIC-related CAT ranged from 3.4 to 63%. Clinical presentation of CAT included symptoms of acute limb ischaemia (79%, 95% CI, 54-97), arterial hypertension (55%, 95% CI, 23-86) and congestive heart failure (28%, 95% CI, 7-53). Underlying conditions of UAC-related CAT included prematurity (70%, 95% CI, 31-98), respiratory distress syndrome (56%, 95% CI, 46-65), asphyxia (41%, 95% CI, 15-69), infection (32%, 95% CI, 13-55), persistent ductus arteriosus (28%, 95% CI, 13-45), meconium aspiration (16%, 95% CI, 8-25) and congenital heart disease (9%, 95% CI, 2-19). Congenital heart disease was the likely condition in EIC- and CC-related CAT. Antithrombotic treatment included thrombolysis (71%, 95% CI, 47-91), heparin (70%, 95% CI, 41-94) and thrombectomy (46%, 95% CI, 10-95) alone or in combination. Complete resolution rate of CAT was 82% (95% CI, 65-96). Long-term complications included arterial hypertension (26%, 95% CI, 0-66) and limb amputation (12%, 95% CI, 1-31). The overall all-cause mortality rate was 7% (95% CI, 2-14). In conclusion, CAT occurs at an increased incidence in neonates and children and is potentially associated with poor outcome. However, limited data are available on paediatric CAT. This systematic review identifies the rationale for further studies on CAT in paediatric patients.
导管相关的动脉血栓形成（CAT）在儿童中越来越被认识到。现有的数据很少，并且基于专家意见。本系统评价旨在确定儿科 CAT 的知识。在 3484 篇出版物中，有 22 篇符合纳入标准。其中 14 篇报道了脐动脉导管（UAC）引起的 CAT，2 篇报道了四肢留置导管（EIC）引起的 CAT，1 篇报道了两者都引起的 CAT，5 篇报道了心脏导管（CC）引起的 CAT。CAT 的总体累积发生率为 21%（95%置信区间[CI]，13-31），UAC 相关 CAT 的相对发生率为 20%（95%CI，10-33），CC 相关 CAT 的相对发生率为 11%（95%CI，3-21）。EIC 相关 CAT 的发生率范围为 3.4%至 63%。CAT 的临床表现包括急性肢体缺血的症状（79%，95%CI，54-97），动脉高血压（55%，95%CI，23-86）和充血性心力衰竭（28%，95%CI，7-53）。UAC 相关 CAT 的潜在疾病包括早产（70%，95%CI，31-98），呼吸窘迫综合征（56%，95%CI，46-65），窒息（41%，95%CI，15-69），感染（32%，95%CI，13-55），持续性动脉导管未闭（28%，95%CI，13-45），胎粪吸入（16%，95%CI，8-25）和先天性心脏病（9%，95%CI，2-19）。先天性心脏病可能是 EIC 和 CC 相关 CAT 的潜在疾病。抗血栓治疗包括溶栓（71%，95%CI，47-91），肝素（70%，95%CI，41-94）和血栓切除术（46%，95%CI，10-95）单独或联合使用。CAT 的完全缓解率为 82%（95%CI，65-96）。长期并发症包括动脉高血压（26%，95%CI，0-66）和肢体截肢（12%，95%CI，1-31）。总的全因死亡率为 7%（95%CI，2-14）。总之，新生儿和儿童中 CAT 的发生率增加，且可能与不良预后相关。然而，儿科 CAT 的现有数据有限。本系统评价确定了进一步研究儿科患者 CAT 的理由。
