预防术后心脏患儿导管相关性血栓形成的依诺肝素：一项中断时间序列分析。

Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis.

机构信息

Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN.

Division of Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN.

出版信息

Pediatr Crit Care Med. 2022 Oct 1;23(10):774-783. doi: 10.1097/PCC.0000000000003010. Epub 2022 Jun 14.

DOI:10.1097/PCC.0000000000003010

PMID:35699766

Abstract

OBJECTIVES

The effectiveness of pharmacologic prophylaxis against catheter-associated thrombosis in children is unclear. We evaluated the compliance and outcomes associated with a prophylactic enoxaparin protocol in postoperative cardiac children.

DESIGN

The protocol was implemented as a quality improvement initiative and then analyzed using interrupted time series method. Data collected from November 2014 to December 2018 were divided into preprotocol (period 1), protocol implementation (period 2), and protocol revision (period 3).

SETTING

A 12-bed academic pediatric cardiac ICU.

PATIENTS

Children less than or equal to 18 years old with congenital heart disease admitted postoperatively with central venous catheter in situ for greater than or equal to 1 day.

INTERVENTIONS

Before 2016, prophylactic enoxaparin was administered according to physician preference. In January 2016, an enoxaparin protocol was implemented with a goal anti-Xa range of 0.25-0.49 international units/mL. Protocol was revised in February 2017 to increase the starting dose by 25% for infants less than 1 year old.

MEASUREMENTS AND MAIN RESULTS

We analyzed 780 hospitalizations from 636 children. Median percentage of catheter-days on prophylactic enoxaparin was 33% (interquartile range [IQR], 23-47%), 42% (IQR, 30-51%), and 38% (IQR, 35-52%) in periods 1-3, respectively. Percentage of catheter-days on enoxaparin showed immediate increase of 90% (95% CI, 17-210%) between periods 1 and 2 and sustained increase of 2% (95% CI, 0.3-4%) between periods 2 and 3. Median rates of thrombosis per 1,000 catheter-days were 5.8 (IQR, 0-9.3), 3.8 (IQR, 0-12), and 0 (IQR, 0-5.3) in periods 1-3, respectively. Rate of thrombosis showed immediate decrease of 67% (95% CI, 12-87%) between periods 1 and 2 and sustained decrease of 11% (95% CI, 2-18%) between periods 1 and 3.

CONCLUSIONS

The temporal association between increase in percentage of catheter-days on enoxaparin and decrease in rate of thrombosis suggests the effectiveness of prophylactic enoxaparin.

摘要

目的

预防导管相关性血栓形成的药物预防在儿童中的有效性尚不清楚。我们评估了术后心脏患儿中预防性依诺肝素方案的依从性和结局。

设计

该方案作为一项质量改进计划实施，并使用中断时间序列法进行分析。数据收集自 2014 年 11 月至 2018 年 12 月，分为方案前（第 1 期）、方案实施（第 2 期）和方案修订（第 3 期）。

地点

12 床学术儿科心脏 ICU。

患者

年龄小于或等于 18 岁，患有先天性心脏病，术后接受中央静脉导管置管，时间大于或等于 1 天。

干预措施

在 2016 年之前，依诺肝素的预防使用取决于医生的偏好。2016 年 1 月，实施了依诺肝素方案，目标抗 Xa 范围为 0.25-0.49 国际单位/毫升。2017 年 2 月，方案修订将 1 岁以下婴儿的起始剂量增加 25%。

测量和主要结果

我们分析了 636 名儿童的 780 例住院治疗。在第 1-3 期，导管天数的预防用依诺肝素中位数百分比分别为 33%（IQR，23-47%）、42%（IQR，30-51%）和 38%（IQR，35-52%）。第 1 期和第 2 期之间依诺肝素导管天数百分比立即增加 90%（95%CI，17-210%），第 2 期和第 3 期之间持续增加 2%（95%CI，0.3-4%）。每 1000 个导管日的血栓形成率分别为第 1-3 期的 5.8（IQR，0-9.3）、3.8（IQR，0-12）和 0（IQR，0-5.3）。第 1 期和第 2 期之间血栓形成率立即下降 67%（95%CI，12-87%），第 1 期和第 3 期之间持续下降 11%（95%CI，2-18%）。