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Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Thromb+Haemost 2014 ; 12 (7): 1096-109 Nephropedia Template TP
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CENTRAL VENOUS CATHETER-RELATED THROMBOSIS AND THROMBOPROPHYLAXIS IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS #MMPMID24801495
Vidal E; Sharathkumar A; Glover J; Faustino EVS
J Thromb Haemost 2014[Jul]; 12 (7): 1096-109 PMID24801495show ga
OBJECTIVES: In preparation for a pediatric randomized controlled trial on thromboprophylaxis, we determined the frequency of catheter-related thrombosis in children. We also systematically reviewed the pediatric trials on thromboprophylaxis to evaluate its efficacy and to identify possible pitfalls in the conduct of these trials. PATIENTS/METHODS: We searched MEDLINE, EMBASE, Web of Science and Cochrane Central Register for Controlled Trials for articles published until December 2013. We included cohort studies and trials on patients 0?18 years old with central venous catheter actively surveilled for thrombosis with radiologic imaging. We estimated the pooled frequency of thrombosis and the pooled risk ratio (RR) with thromboprophylaxis using random effects model. RESULTS: Of 2,651 articles identified, we analyzed 37 articles with 3,128 patients. The pooled frequency of thrombosis was 0.20 (95% confidence interval [CI]: 0.16?0.24). Of 10 trials, we did not find evidence that heparin-bonded catheter (RR: 0.34; 95% CI: 0.01?7.68), unfractionated heparin (RR: 0.93; 95% CI: 0.57?1.51), low molecular weight heparin (RR: 1.13; 95% CI: 0.51?2.50), warfarin (RR: 0.85; 95% CI: 0.34?2.17), antithrombin concentrate (RR: 0.76; 95% CI: 0.38?1.55) and nitroglycerin (RR: 1.53; 95% CI: 0.57?4.10) reduced the risk for thrombosis. Most of the trials were either not powered for thrombosis or powered to detect large, likely unachievable, reductions in thrombosis. Missing data on thrombosis also limited these trials. CONCLUSIONS: Catheter-related thrombosis is common in children. An adequately powered multicenter trial that can detect a modest, clinically significant, reduction in thrombosis is critically needed. Missing outcome data should be minimized in this trial.