Thromboprophylaxis of central venous lines in children with cancer: the first steps taken on the long road ahead.
Approximately one third of children with malignancy and central venous lines develop catheter-related thrombosis, with the reported sequelae including death, pulmonary embolism, chylothoraces, superior vena cava syndrome and post-thrombotic syndrome. These complications prompt the design and completion of randomized, controlled trials to determine a safe and efficacious therapy to prevent these thromboses. The authors Ruud et al. have presented a well-designed, randomized, controlled trial which demonstrates the lack of utility of using low-dose warfarin to prevent catheter-related thrombosis in children with central lines and acute lymphoblastic leukaemia. The difficulties with warfarin in children are again demonstrated in this study.


CONCLUSIONS
Further studies are warranted using other thromboprophylactic agents with less or no monitoring and fewer drug interactions, including the newer anticoagulant agents such as direct thrombin inhibitors.
Massicotte
Patricia
P
Department of Paediatrics, University of Alberta, Edmonton, Canada. pattimassicotte@cha.ab.ca
Mitchell
Lesley
L
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin