title: Prophylactic anticoagulation decreases catheter-related thrombosis and occlusion in children with home parenteral nutrition.
abstract: BACKGROUND
  Home parenteral nutrition (PN) has improved the survival of children with intestinal failure. Important complications include catheter-related thrombosis, occlusion, and infection. This study evaluated the efficacy and safety of prophylactic anticoagulation in the prevention of these complications.
  
  
  METHODS
  Medical records were retrospectively reviewed of all children (0-18 years) with PN between January 1994 and March 2007 in 1 tertiary center. After introduction of prophylactic low molecular weight heparin or vitamin K antagonists in March 2007, all patients were prospectively followed until March 2010.
  
  
  RESULTS
  In sum, 14 patients did not receive prophylaxis; 13 switched from no prophylaxis to prophylaxis in March 2007; and 5 directly received prophylaxis. Median age of PN onset was 4 months (range, 0.1-202) in the nonprophylaxis group (n = 27) and 25 (range, 2-167) in the prophylaxis group (n = 18); 16 children received low molecular weight heparin and 2, vitamin K antagonists. Catheter-related thrombosis developed in 9 patients with no prophylaxis (33%) and 1 with prophylaxis (6%) (P = .034). Cumulative 5-year thrombosis-free survival was 48% and 93% in the nonprophylaxis and prophylaxis groups, respectively (P = .047). Per 1,000 PN days, the nonprophylaxis and prophylaxis groups had 2.6 and 0.1 occlusions (P = .04) and 4.6 and 2.1 infections (P = .06), respectively. Cumulative infection-free survival after 3 years was 19% and 46% in the nonprophylaxis and prophylaxis groups, respectively (P = .03). Bleeding complications did not occur.
  
  
  CONCLUSIONS
  Thromboprophylaxis significantly decreased catheter-related thrombosis and occlusion in children with PN without complications.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital / Academic Medical Center, Amsterdam, Netherlands.
authors.forename: I L
authors.initials: IL
authors.lastname: Vegting
authors.forename: M M
authors.initials: MM
authors.lastname: Tabbers
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
authors.forename: J C
authors.initials: JC
authors.lastname: Wilde
authors.forename: M J
authors.initials: MJ
authors.lastname: Serlie
authors.forename: T A
authors.initials: TA
authors.lastname: Tas
authors.forename: C F
authors.initials: CF
authors.lastname: Jonkers
authors.forename: C H
authors.initials: CH
authors.lastname: van Ommen
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation / Q000187:drug effects*; D002405:Catheterization, Central Venous / Q000379:methods; D057785:Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004341:Drug Evaluation; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D016331:Parenteral Nutrition, Home / Q000379:methods*; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use
chemical_list: D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K