Central venous catheter-related thrombosis in children and adults. Issue 187 (March 2020) - Citla Sridhar, Divyaswathi
Abstract: Central venous catheters (CVC) have revolutionized the care of patients requiring long-term venous access. With increasing use of CVCs, the incidence of catheter-related thrombosis (CRT) has been on the rise. CRT constitutes 10% of all deep venous thromboses (DVT) in adults and 50–80% of all DVTs among children. The incidence of CRT varies significantly based on patient characteristics, catheter-related factors and the steps involved in the process of catheter insertion. Multiple risk factors have been associated with a higher risk of CRT, including older age, hospitalization, CVC insertion in the subclavian vein, left-sided CVC insertion, longer duration of catheter, catheter-to-vein ratio > 0.45, and type of CVC. A majority of patients with CRT are asymptomatic. Duplex ultrasound is the initial diagnostic modality of choice, though other modalities like CT angiography and MRV may be necessary for certain CRT locations. Current guidelines recommend maintaining a catheter unless nonfunctional or unneeded, in addition to systemic anticoagulation. Data guiding anticoagulant management specific to upper extremity VTE is lacking, and practice is mostly extrapolated from data on lower extremities. Further studies are required to establish evidence-based guidelines in the management of adults and children with CRT, and in particular the role of direct oral anticoagulants. In this review, we describe the knowledge gaps that exist in multiple aspects of CRT and the need for large collaborative studies to improve the care of patients with CRT. Highlights: Central venous catheter use is on the rise, as is catheter-related thrombosis (CRT). CRT is the single most common form of thrombosis seen in children. Subclavian vein catheters, PICC's and left-sided catheters are risk factors for CRT. Guidelines for CRT treatment are extrapolated from lower extremity thrombosis. Studies for new, novel anticoagulants are needed for treatment and prevention of CRT.