Children's Hospital Los Angeles, Los Angeles, California, USA.
Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
J Thromb Haemost. 2022 Jan;20(1):133-137. doi: 10.1111/jth.15548. Epub 2021 Oct 19.
Appropriate timing of central venous catheter (CVC) removal, in relation to start of anticoagulation, in children after the diagnosis of a CVC-related thrombosis (CRT) is not well established.
This retrospective cohort study evaluated the incidence of symptomatic pulmonary embolism (PE) after CVC removal using data from the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) Consortium Registry.
PATIENTS/METHODS: The CHAT Registry consists of data from children aged 0-21 years with a hospital-acquired venous thromboembolism. Eligible subjects were those with CRT diagnosed <3 days after CVC removal. Subjects were excluded if the CRT was due to a failed CVC insertion. Subjects were divided into three groups: those with CVC removal without anticoagulation, those with CVC removal <48 h after starting anticoagulation, and those with CVC removal ≥48 h after starting anticoagulation.
A total of 687 CRT events from 663 subjects were included. A majority of CRT events were in subjects with peripherally inserted central catheters (62.3%, n = 428). For the 611 CRT events in which the CVC was removed, there was only one case of symptomatic PE (0.16%), which occurred <48 h after initiation of anticoagulation.
While current guidelines suggest anticoagulation before CVC removal in the setting of a CRT to prevent embolization, CVC removal is not associated with symptomatic PE regardless of duration of anticoagulation before CVC removal.
儿童中心静脉导管（CVC）相关性血栓（CRT）诊断后，CVC 何时拔除并开始抗凝治疗，目前尚无定论。
本回顾性队列研究利用多机构儿童医院获得性血栓形成（CHAT）联盟登记处的数据，评估 CVC 拔除后发生症状性肺栓塞（PE）的发生率。
患者/方法：CHAT 登记处包含了年龄在 0-21 岁的因医院获得性静脉血栓栓塞住院的儿童数据。符合条件的研究对象为 CRT 在 CVC 拔除后<3 天确诊的患者。如果 CRT 是由于 CVC 插入失败引起的，则将患者排除在外。将患者分为三组：未抗凝时拔除 CVC 组、抗凝开始后<48 小时拔除 CVC 组和抗凝开始后≥48 小时拔除 CVC 组。
共纳入 687 例 CRT 事件，涉及 663 例患者。大多数 CRT 事件发生在经外周插入中心静脉导管（62.3%，n=428）的患者中。在 611 例 CVC 拔除的 CRT 事件中，仅 1 例（0.16%）发生症状性 PE，发生在抗凝开始后<48 小时。
虽然目前的指南建议 CRT 患者在拔除 CVC 前进行抗凝治疗以预防栓塞，但无论在 CVC 拔除前抗凝时间长短如何，CVC 拔除均与症状性 PE 无关。
