Abstract
Background: In critically ill (preterm) neonates, catheter-related venous thrombosis (CVT) can be a life-threatening complication. CVT management varies among neonatal intensive care units (NICUs). In the Netherlands, a consensus-based national management guideline has been developed to create uniform CVT management, which was implemented in all 10 Dutch NICUs in 2014.
Aims: To evaluate the efficacy and safety of the Dutch neonatal CVT management guideline.
Methods: This multicentre prospective observational cohort study included (preterm) neonates (0-6 months) with CVT, admitted to one of the 10 Dutch NICUs between 2014 and 2019. CVT management was divided into treatment of CVT in veins or right atrium (RA); algorithms are shown in figure 1. Primary outcomes were death due to CVT, recurrent thrombosis, major bleeding. Secondary outcomes were clinically relevant bleeding and thrombotic burden at the end of treatment.
Management neonatal venous catheter-related thrombosis according to NEOCLOT guideline. Abbreviations: RA right atrium, WS wait and see, US ultrasonography, r-tPA recombinant tissue plasminogen activator
Results: Totally, 116 neonates were included (male: n=71;preterm: n=92) with median gestational age 28 4/7 weeks (range:24-41 4/7), and median birthweight 1092 gram (range: 425-5384). Symptoms occurred in 87 (75%) neonates, including thrombocytopenia (43%), persisting infection (26%) or swollen leg/arm (24%). Risk factors were (suspected) infection (60%), surgery (12%), shock (11%). Applied management is shown in table 2. One (0.9%) neonate died due to pulmonary embolism, 3 (2.6%) neonates had recurrent thrombosis. Major bleeding occurred in 9 (7.8%) neonates: 2 on thrombolysis (intracranial and lung bleeding), 7 on low-molecular-weight heparin (LMWH), of which 5/7 had subcutaneous catheter-related major bleeding in the leg. One neonate had 1 clinically relevant gastro-intestinal bleeding. At the end of treatment, repeat ultrasonography (after median 49 days) was normalized, improved, unchanged or unknown in 54 (47%), 42 (36%), 9 (8%) and 11 (9%) neonates, respectively.
Type thrombosis Management
Vein
n=72 Occlusion
n=39 n=11: Wait and see
n=27: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Non-occlusion
n=33 n=28: Wait and see
n=4: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Right atrium
n=44 High risk
n=9 n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=2: r-TPA – anticoagulation
<half right atrium
n=35 n=23: Wait and see
n=4: Wait and see – anticoagulation.
n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=1: Wait and see – anticoagulation – r-TPA – anticoagulation
>= half right atrium
n=0
Management of 116 neonates with catheter-related venous thrombosis. Abbreviations: r-tPA, recombinant tissue plasminogen activator
Conclusions: Management of neonatal CVT according to the NEOCLOT protocol seems to be effective and safe, when not using subcutaneous catheters for LMWH administration.
Aims: To evaluate the efficacy and safety of the Dutch neonatal CVT management guideline.
Methods: This multicentre prospective observational cohort study included (preterm) neonates (0-6 months) with CVT, admitted to one of the 10 Dutch NICUs between 2014 and 2019. CVT management was divided into treatment of CVT in veins or right atrium (RA); algorithms are shown in figure 1. Primary outcomes were death due to CVT, recurrent thrombosis, major bleeding. Secondary outcomes were clinically relevant bleeding and thrombotic burden at the end of treatment.
Management neonatal venous catheter-related thrombosis according to NEOCLOT guideline. Abbreviations: RA right atrium, WS wait and see, US ultrasonography, r-tPA recombinant tissue plasminogen activator
Results: Totally, 116 neonates were included (male: n=71;preterm: n=92) with median gestational age 28 4/7 weeks (range:24-41 4/7), and median birthweight 1092 gram (range: 425-5384). Symptoms occurred in 87 (75%) neonates, including thrombocytopenia (43%), persisting infection (26%) or swollen leg/arm (24%). Risk factors were (suspected) infection (60%), surgery (12%), shock (11%). Applied management is shown in table 2. One (0.9%) neonate died due to pulmonary embolism, 3 (2.6%) neonates had recurrent thrombosis. Major bleeding occurred in 9 (7.8%) neonates: 2 on thrombolysis (intracranial and lung bleeding), 7 on low-molecular-weight heparin (LMWH), of which 5/7 had subcutaneous catheter-related major bleeding in the leg. One neonate had 1 clinically relevant gastro-intestinal bleeding. At the end of treatment, repeat ultrasonography (after median 49 days) was normalized, improved, unchanged or unknown in 54 (47%), 42 (36%), 9 (8%) and 11 (9%) neonates, respectively.
Type thrombosis Management
Vein
n=72 Occlusion
n=39 n=11: Wait and see
n=27: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Non-occlusion
n=33 n=28: Wait and see
n=4: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Right atrium
n=44 High risk
n=9 n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=2: r-TPA – anticoagulation
<half right atrium
n=35 n=23: Wait and see
n=4: Wait and see – anticoagulation.
n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=1: Wait and see – anticoagulation – r-TPA – anticoagulation
>= half right atrium
n=0
Management of 116 neonates with catheter-related venous thrombosis. Abbreviations: r-tPA, recombinant tissue plasminogen activator
Conclusions: Management of neonatal CVT according to the NEOCLOT protocol seems to be effective and safe, when not using subcutaneous catheters for LMWH administration.
| Original language | English |
|---|---|
| Publication status | Published - 2021 |
| Event | International society on Thrombosis and Haemostasis: ISTH - online Duration: 17 Jul 2021 → 21 Jul 2021 https://abstracts.isth.org |
Conference
| Conference | International society on Thrombosis and Haemostasis |
|---|---|
| Period | 17/07/21 → 21/07/21 |
| Internet address |
Keywords
- Thrombosis
- neonate