Division of Hematology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
Intensive Care and Neonatology Unit, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
J Pediatr. 2021 Dec;239:182-186. doi: 10.1016/j.jpeds.2021.08.035. Epub 2021 Aug 24.
To investigate treatment modalities for children with extremity indwelling catheter (EIC)- or cardiac catheter-related arterial thrombosis.
The treatment of consecutive cases of catheter-related arterial thrombosis (CAT) at our institution between 2002 and 2017 was analyzed retrospectively.
A total of 242 CATs developed in 224 children. Of these, 125 (52%) were EIC-related and 117 (48%) were cardiac catheter-related. Treatment included heparin alone in 60 cases (25%), acetylsalicyclic acid (ASA) alone in 6 cases (2%), heparin followed by ASA in 171 cases (71%), heparin followed by vitamin K antagonist (VKA) in 4 cases (1.5%), and VKA alone in 1 case (0.5%). Complete resolution of CAT was observed in 173 cases (71.5%), partial resolution in 13 cases (5.4%), and no resolution in 56 cases (23.1%). No statistical significance in the resolution rate was observed between treatment groups (P = .23). In 66% of cases, complete resolution occurred at a median of 18 days (range, 4-44 days) with heparin alone. A switch from heparin to ASA in children with partial or no resolution of CAT did not increase the resolution rate at follow-up.
Heparin is an efficient treatment modality for CAT in pediatric patients. Long-term, subsequent treatment with ASA does not increase the resolution rate.
探讨儿童肢体留置导管（EIC）或心导管相关动脉血栓形成的治疗方法。
回顾性分析了 2002 年至 2017 年期间我院连续发生的导管相关动脉血栓形成（CAT）病例的治疗情况。
224 例儿童共发生 242 例 CAT，其中 125 例（52%）为 EIC 相关，117 例（48%）为心导管相关。治疗包括肝素单独治疗 60 例（25%）、乙酰水杨酸（ASA）单独治疗 6 例（2%）、肝素后继以 ASA 治疗 171 例（71%）、肝素后继以维生素 K 拮抗剂（VKA）治疗 4 例（1.5%）、VKA 单独治疗 1 例（0.5%）。173 例（71.5%）CAT 完全缓解，13 例（5.4%）部分缓解，56 例（23.1%）无缓解。各组间的缓解率无统计学差异（P=0.23）。肝素单独治疗的中位缓解时间为 18 天（4-44 天），66%的病例完全缓解。对于 CAT 部分或无缓解的患儿，从肝素转为 ASA 并不能提高缓解率。
肝素是儿科患者 CAT 的有效治疗方法。长期后续应用 ASA 并不能提高缓解率。
