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Deep Venous Thrombosis Screening in Patients with Inherited Bleeding Disorders and Central Venous Catheters
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Details:
  • Pubmed ID:
    21435117
  • Pubmed Central ID:
    PMC4134000
  • Description:
    Introduction

    Children with inherited bleeding disorders often require central venous catheters (CVC). Although CVCs are known to be complicated by deep venous thrombosis (DVT), little is known about the timeline of DVT development or risk of post-thrombotic syndrome (PTS).

    Aim

    To determine the timeline and confirm the incidence of thrombosis in patients with bleeding disorders who have CVCs.

    Methods

    In 2002 we instituted a screening program to monitor for CVC-related complications in children with hemophilia and von Willebrand disease. This is a retrospective review of this cohort. All children with CVC followed between January 1, 2000 and June 1, 2009 were evaluated for DVT every 24 months with contrast venography and Doppler sonography. An institutional PTS severity scale was utilized at each visit.

    Results

    Thirty-six patients had 37 CVCs placed. Thirty patients had imaging studies, with DVT observed in 14 (47%). Most DVT were diagnosed at the first venogram (median CVC duration 26 months). There were no abnormal ultrasound results. Sixteen patients (44%) had clinical findings consistent with PTS, including 10 (71%) with an abnormal venogram. Dilated chest wall veins appeared to be more strongly associated with underlying DVT (positive predictive value of 0.8) than arm circumference discrepancy. Successful transition to use of peripheral veins occurred at a median of 11 months after abnormal venograms.

    Conclusions

    CVC-related DVT is common in children with inherited bleeding disorders, and likely occurs earlier than previously thought. Clinical signs of PTS are also common, but long-term sequelae and severity of PTS are not known.

  • Document Type:
  • Collection(s):
  • Funding:
    H30 MC00029/PHS HHS/United States
    K23 HL084097/HL/NHLBI NIH HHS/United States
    K23 HL084097/HL/NHLBI NIH HHS/United States
    K23 HL084097-05/HL/NHLBI NIH HHS/United States
    T32 CA009640/CA/NCI NIH HHS/United States
    T32 CA009640/CA/NCI NIH HHS/United States
    T32 CA009640-13/CA/NCI NIH HHS/United States
    U01 DD000196/DD/NCBDD CDC HHS/United States
    UL1 RR024982/RR/NCRR NIH HHS/United States
    UL1 RR024982-05/RR/NCRR NIH HHS/United States
    UL1-RR024982/RR/NCRR NIH HHS/United States
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