Treatment Approaches and Outcomes of Central Vascular Catheter-related Thrombosis in Neonates: A Canadian Retrospective Cohort Study.

Abstract

Background: Management of neonatal central vascular catheter (CVC)-related thromboembolism is complex, as the higher risk of bleeding must be balanced with the thrombotic risks.

Objectives: To describe management of neonatal CVC-related thrombosis and to compare the effectiveness and safety between treatment modalities.

Methods: A multicenter retrospective cohort study enrolled neonates ≤ 28 days requiring a CVC with a radiologically confirmed thrombosis. Data from the Canadian Neonatal Network database were linked to clinical outcomes in individual medical records, namely, thrombosis resolution and thrombosis progression, major bleeding and clinically relevant non-major bleeding defined using ISTH criteria. Multivariable logistic regression explored predictors of anticoagulation use and whether treatment modality predicted clinical outcomes.

Results: A total of 497 neonates sustained a CVC-related thrombosis (83% venous, 16% arterial). Older gestational age, the absence of hypoxic-ischemic encephalopathy, occlusive, and non-portal thrombosis were associated with anticoagulation use for venous thrombosis; only older gestational age predicted anticoagulation use for arterial thrombosis. Complete thrombosis resolution and progression occurred in 38.3% (95%CI: 33.5-43.2%) and 2.0% (95%CI: 0.9-4.4%) of patients, respectively. Anticoagulation was not associated with complete resolution of thrombosis (adjusted OR: 0.83, adjusted 95%CI: 0.46-1.50, p = 0.531) or thrombosis progression (OR: 3.41, 95%CI: 0.65-17.86, p = 0.146) for venous events, but was associated with higher rates of resolution (aOR: 5.66, a95%CI: 1.96-16.31, p = 0.001) in arterial events. Anticoagulation was not associated with increased risk of clinically significant bleeding (aOR: 1.75, a95%CI: 0.92-3.31, p = 0.086).

Conclusion: Thrombotic progression was rare and not associated with anticoagulation. Anticoagulation was often withheld in neonates with less thrombotic risk factors or in presence of bleeding risk factors.