Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
Curr Opin Pediatr. 2022 Jun 1;34(3):273-278. doi: 10.1097/MOP.0000000000001128.
Central venous catheter (CVC) placement and ICU admission are the two most important risk factors for pediatric deep vein thrombosis. The optimal prevention and treatment strategies for CVC-associated deep vein thrombosis (CADVT) are unclear, but recently, seminal studies have been published. This review aims to summarize the recent literature on CADVT in critically ill children.
Recent publications focused on three themes: risk factors, prevention, and treatment of CADVT. Newly identified risk factors for CADVT relate to Virchow's triad of hemostasis, blood vessel injury, and hypercoagulability. New risk prediction models have moderately good accuracy in predicting CADVT. Though previous data on pharmacologic CADVT prophylaxis was equivocal, recent studies indicate that low-molecular-weight heparin may be effective in preventing CADVT, particularly in critically ill children. Finally, new studies suggest that direct oral anticoagulants and shorter treatment times are noninferior to traditional agents and treatment durations in the treatment of CADVT.
Recent research suggests new ways to accurately identify children at high risk of CADVT, effectively prevent CADVT, and optimize CADVT treatment. Future research should focus on understanding the pathobiology of CADVT formation, prevention, and treatment in critically ill children.
中心静脉导管（CVC）置管和入住 ICU 是小儿深静脉血栓形成（DVT）的两个最重要的危险因素。目前对于与 CVC 相关的深静脉血栓形成（CADVT）的最佳预防和治疗策略仍不明确，但最近已有重要研究发表。本综述旨在总结目前关于危重症患儿 CADVT 的文献。
最近的出版物集中在三个主题：CADVT 的危险因素、预防和治疗。新发现的 CADVT 危险因素与止血、血管损伤和血液高凝状态的 Virchow 三联征有关。新的风险预测模型对 CADVT 的预测具有较好的准确性。尽管以前关于 CADVT 药物预防的数据存在争议，但最近的研究表明，低分子量肝素可能对预防 CADVT 有效，特别是对危重症患儿。最后，新的研究表明，直接口服抗凝剂和较短的治疗时间与传统药物和治疗时间相比，在 CADVT 的治疗中同样有效。
最近的研究为准确识别 CADVT 高危患儿、有效预防 CADVT 以及优化 CADVT 治疗提供了新的思路。未来的研究应侧重于了解危重症患儿 CADVT 形成、预防和治疗的病理生理学。
