Central Venous Line Associated Deep Vein Thrombosis in Hospitalized Children

We have shown that the administration of intravenous (IV) lignocaine 2mg/min commenced prior to surgery is associated with a marked reduction in the total incidence of deepvein thrombosis (DVT), In particular, thigh vein thrombus was absent, after elective hip surgery. (Lancet 2, 797 - 799, 1977). The present investigation was to determine the effect of a lesser dose of IV and of Intramuscular (IM) lignocaine. In 25 patients IV lignocaine 1mg/min was administered by central venous line, starting 4 hours before, and during the first week following, surgery. Thereafter in 11 of these patients lignocaine was administered intramuscularly; 200mg 4 hourly in 7 patients and 300mg 4 hourly in 4 patients. Monitoring for DVT was by thermography, performed pre-operatively and daily postoperatively until discharge. Phlebography was performed in all cases either when thermography became positive or on the 14th postoperative day. During the administration of IV lignocaine the total incidence of DVT was 32 per cent (expected incidence 70 - 80%) wIth an incidence of thigh vein thrombosis of 25 per cent (expected incidence 50%). The incidence of DVT during IM lignocaine using either dosage regime was similar to the expected incidence of DVT in patients receiving no prophylaxis. We conclude that the effect of lignocaine in the prophylaxis of DVT following hip surgery is both route and dosage dependent.

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Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

European Journal of Pediatrics ◽

10.1007/s00431-021-03985-5 ◽

2021 ◽

Author(s):

Miguel García-Boyano ◽

José Manuel Caballero-Caballero ◽

Marta García Fernández de Villalta ◽

Mar Gutiérrez Alvariño ◽

María Jesús Blanco Bañares ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Central Venous Access Device ◽

Access Device ◽

Vein Thrombosis ◽

Venous Access Device ◽

Deep Vein

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Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia

Blood ◽

10.1182/blood-2002-05-1448 ◽

2003 ◽

Vol 101 (8) ◽

pp. 3049-3051 ◽

Cited By ~ 114

Author(s):

Aaron P. Hong ◽

Deborah J. Cook ◽

Christopher S. Sigouin ◽

Theodore E. Warkentin

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Orthopedic Surgery ◽

Venous Catheter ◽

Central Venous Catheters ◽

Central Venous ◽

Heparin Induced Thrombocytopenia ◽

Vein Thrombosis ◽

Deep Vein ◽

Limb Deep Vein Thrombosis

Abstract Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT—either with or without central venous catheter (CVC) use—is unknown. We therefore studied 260 patients with antibody-positive HIT to determine the influence of CVC use on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). Compared with the control populations, both upper- and lower-extremity DVTs were found to be associated with HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (14 of 145 [9.7%]) versus none of 115 (0%) patients without a CVC (P = .000 35). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.

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Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.C Vedovati ◽

G Tratar ◽

A Mavri ◽

L Pierpaoli ◽

G Agnelli ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Pacemaker Implantation ◽

Limb Ischemia ◽

Central Venous Line ◽

Upper Extremities ◽

Acute Limb Ischemia ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited. Purpose To assess the effectiveness and safety of DOACs in the treatment of UEDVT. Methods Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism (VTE). Study outcomes were recurrent VTE and major bleeding (MB) occurring during DOAC treatment. Results Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (Table). Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0–1.05) and anemia (OR 1.35, 95% CI 1.07–1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8–84.4). Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year). Conclusions Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings. Funding Acknowledgement Type of funding source: None

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Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-015-1209-3 ◽

2015 ◽

Vol 40 (3) ◽

pp. 274-279 ◽

Cited By ~ 5

Author(s):

Matthew P. Lungren ◽

Thomas J. Ward ◽

Manish N. Patel ◽

John M. Racadio ◽

Kamlesh Kukreja

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein ◽

Initial Results

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Upper-extremity deep vein thrombosis related to central venous port systems implanted in cancer patients

British Journal of Radiology ◽

10.1259/bjr/41019720 ◽

2010 ◽

Vol 83 (994) ◽

pp. 850-853 ◽

Cited By ~ 14

Author(s):

S Yukisawa ◽

Y Fujiwara ◽

Y Yamamoto ◽

T Ueno ◽

K Matsueda ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Cancer Patients ◽

Upper Extremity ◽

Central Venous ◽

Vein Thrombosis ◽

Central Venous Port ◽

Venous Port ◽

Port Systems ◽

Deep Vein

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Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽

10.1182/blood.v106.11.584.584 ◽

2005 ◽

Vol 106 (11) ◽

pp. 584-584

Author(s):

Frederick A. Spencer3 ◽

Robert J. Goldberg ◽

Darleen Lessard ◽

Cathy Emery ◽

Apar Bains ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Central Venous Catheter ◽

Lower Extremity ◽

Upper Extremity ◽

Venous Catheter ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

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Characteristics of Upper Extremity Deep Vein Thrombosis in Hospitalized Patients. a Review of 8350 Admissions from the 2012 National Inpatient Sample

Blood ◽

10.1182/blood.v126.23.2314.2314 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2314-2314

Author(s):

Taeha Kim ◽

Joseph Shatzel ◽

Deborah L Ornstein

Keyword(s):

Deep Vein Thrombosis ◽

Venous Catheter ◽

Hospitalized Patients ◽

Catheter Placement ◽

Red Blood Cell Transfusion ◽

National Inpatient Sample ◽

Central Venous ◽

Central Venous Catheter Placement ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing due to the increased use of central venous catheters. In contrast to lower extremity DVT (LEDVT), there is limited data to guide management, with many current management recommendations based on extrapolation from LEDVT studies. The aim of this study is to evaluate the characteristics and mortality associated with hospitalized patients with UEDVT from a large national database. Methods: Using the 2012 National Inpatient Sample (NIS), admissions with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for UEDVT (453.82) were extracted, and data collected on age, sex, length of stay, mortality, and associated diagnoses and procedures. LEDVT (ICD-9-CM 453.40) data were extracted for comparison. Collected data were used to calculate odds ratios with corresponding 95% confidence intervals and p-values to show associations where applicable. Results: Of the 7,296,968 unweighted admissions in the 2012 NIS, 8,350 were associated with UEDVT, and 18,194 were associated with LEDVT (prevalence of 0.11% vs 0.25%, respectively). UEDVT and LEDVT rates were similar in men and women. However, compared to LEDVT, patients with UEDVT were younger (61yr vs. 67 yr; p<0.0001), had longer mean LOS (14 days (range 0-309) vs. 5 days (range 0-345); p<0.0001), and higher inpatient mortality (7.75% vs 5.34%; OR 1.45, 95% CI 1.31, 1.61; p<0.0001). Pulmonary embolism was less common in UEDVT than in LEDVT (6.2% vs. 25%; OR 0.24, 95% CI 0.22, 0.27; p<0.0001), but significantly more common than the general hospitalized population (6.2% vs. 0.08%; OR 7.7, 95% CI 7.04, 8.42; p<0.0001). Malignancy was slightly more common in patients with UEDVT compared to those with LEDVT (30.1% vs 27.1%; OR 1.11, 95% CI 1.05, 1.17; p=0.0002). UEDVT was associated with central venous catheter placement (OR 10.1, 95% CI 9.56, 10.68; p<0.0001), other venous catheter placement (OR 21.9, 95% CI 20.9, 22.9; p<0.0001), and red blood cell transfusion (OR 3.6, 95% CI 3.47, 3.83; p<0.0001) in the hospitalized population. Procedures most commonly associated with LEDVT were interruption of the vena cava, red blood cell transfusion and other venous catheter placement. Conclusions: UEDVT was less common than LEDVT, and associated with central venous catheter placement and blood transfusions in hospitalized patients. UEDVT tended to occur in younger patients with longer LOS, and was associated with a higher mortality and a slightly higher prevalence of malignancies than LEDVT. PE was less common during admissions with UEDVT than LEDVT, however UEDVT admissions were associated with an increased incidence of PE compared to the general inpatient population. The results of this large epidemiologic study of UEDVT in hospitalized patients contribute to our understanding of this increasingly common disease and will help define strategies for prophylaxis and treatment. Disclosures No relevant conflicts of interest to declare.

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