婴儿症状性导管相关动脉血栓形成患者的特征和治疗结局：一项回顾性队列研究。
Patient Characteristics and Treatment Outcomes of Symptomatic Catheter-Related Arterial Thrombosis in Infants: A Retrospective Cohort Study.
机构信息
Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX.
Department of Radiology, Section of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
出版信息
J Pediatr. 2021 Apr;231:215-222. doi: 10.1016/j.jpeds.2020.12.061. Epub 2020 Dec 24.
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.
目的
描述症状性婴儿导管相关动脉血栓形成的临床特征、结局和治疗不良事件。
研究设计
对一家儿科三级保健中心 8 年来接受抗凝治疗的 99 例（年龄＜365 天）留置动脉导管或心导管后发生导管相关动脉血栓形成的婴儿的单一中心回顾性病历回顾。测量的结局包括血栓进展、出血事件以及治疗期后的血栓溶解。
结果
血栓继发于留置动脉导管放置的有 51 例（51.5%），继发于心导管检查的有 48 例（48.5%）。导管相关动脉血栓形成的中位诊断年龄为 52 天。所有患者均接受了未分馏肝素或低分子肝素的治疗性抗凝治疗，最长达 28 天。8 例（8.1%）患者发生导管相关动脉血栓进展。该队列中发生 1 例（1%）重大出血事件和 3 例（3%）轻微出血事件。治疗后，60 例（60.6%）患者完全溶解血栓，33 例（33.3%）部分溶解血栓，6 例（6.1%）未溶解血栓。与完全血栓溶解相关的因素包括从干预到导管相关动脉血栓形成诊断的时间（中位数为 1 天 vs 5 天，在那些经历血栓溶解的患者与未经历血栓溶解的患者之间，P=.035），以及髂动脉和/或股动脉受累（P=.015）。
结论
我们对婴儿导管相关动脉血栓形成的治疗方法是安全有效的。本研究的局限性在于其为回顾性研究，且仅来自一家机构的患者数量有限。需要进一步开展前瞻性研究以确定婴儿导管相关动脉血栓形成的最佳治疗方法。
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