Antithrombin Activity and Central Venous Catheter-Associated Thrombosis in Critically Ill Children at High Risk of Bleeding

Authors

Tyler Quinn, Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, Connecticut, USA.
Jill M. Cholette, Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, New York, USA.Follow
Matthew G. Pinto, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, New York, USA.Follow
Hilary Schreiber, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Maureen A. Madden, Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Erin Bennett, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Amanda Kolmar, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA.
Alan Poole, Division of Critical Care, UT Southwestern Medical Center, Dallas, Texas, USA.
Cicero T. Silva, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.
Lauren Ehrlich, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.
Oscar M. Navarro, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
E Vincent Faustino, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA. Electronic address: vince.faustino@yale.edu.

Author Type(s)

Faculty

DOI

10.1016/j.jtha.2023.09.023

Journal Title

Journal of Thrombosis and Haemostasis

First Page

213

Last Page

224

Document Type

Article

Publication Date

1-1-2024

Department

Pediatrics

Abstract

BACKGROUND: Normalization of antithrombin activity may prevent catheter-associated thrombosis in critically ill children at high risk of bleeding. OBJECTIVES: To characterize the temporal pattern of antithrombin activity, assess its association with catheter-associated thrombosis and clinically relevant bleeding, and evaluate its relationship with thrombin generation in these children. METHODS: In this prospective cohort study, critically ill children <18 years old at high risk of bleeding with central venous catheter were eligible. Antithrombin activity and thrombin generation were measured from platelet-poor plasma and after in vitro antithrombin supplementation. Systematic surveillance ultrasound was performed to diagnose thrombosis. Children were followed for bleeding. RESULTS: We enrolled 8 infants (median age: 0.2 years, IQR: 0.2, 0.3 years) and 72 older children (median age: 14.3 years, IQR: 9.1, 16.1 years). Mean antithrombin on the day of catheter insertion was 64 IU/dL (SD: 32 IU/dL) in infants and 83 IU/dL (SD: 35 IU/dL) in older children. Antithrombin normalized by the day of catheter removal. Thrombosis developed in 27 children, while 31 children bled. Thrombosis (regression coefficient: 0.008, 95% CI: -0.01, 0.03) and bleeding (regression coefficient: -0.0007, 95% CI: -0.02, 0.02) were not associated with antithrombin. Antithrombin was not correlated with in vivo change in endogenous thrombin potential (correlation coefficient: -0.07, 95% CI: -0.21, 0.08). In vitro supplementation reduced endogenous thrombin potential (correlation coefficient: -0.78; 95% CI: -0.95, -0.23). CONCLUSION: These findings may not support normalization of antithrombin activity to prevent catheter-associated thrombosis in critically ill children at high risk of bleeding.

Recommended Citation

Quinn, T., Cholette, J. M., Pinto, M. G., Schreiber, H., Madden, M. A., Bennett, E., Kolmar, A., Poole, A., Silva, C. T., Ehrlich, L., Navarro, O. M., & Faustino, E. V. (2024). Antithrombin Activity and Central Venous Catheter-Associated Thrombosis in Critically Ill Children at High Risk of Bleeding. Journal of Thrombosis and Haemostasis, 22 (1), 213-224. https://doi.org/10.1016/j.jtha.2023.09.023