title: Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study.
abstract: BACKGROUND
  To date, no study has investigated the use of vitamin K antagonists (VKA) in children undergoing chronic haemodialysis (HD) with a central venous catheter (CVC).
  
  
  METHODS
  Consecutive patients aged <18 years with a newly placed tunnelled CVC for chronic HD were enrolled over a 3-year period. Children with active nephrotic syndrome or a history of venous thrombosis received warfarin (VKA group) with therapeutic target international normalised ratios of between 2.0 and 3.0. Patients at standard risk of CVC malfunction were not treated with VKA (standard group). The primary end-point was overall CVC survival.
  
  
  RESULTS
  The VKA group consisted of nine patients (median age 10.6 years; range 1.2-15.3 years) with 11 CVC, and the standard group comprised eight patients (11.8 years; 6.1-17.3 years) with ten CVC. The 6- and 12-month CVC survival was significantly longer in the VKA group than in the standard group (100 vs. 60 % and 83.3 vs. 16.7 %, respectively; p < 0.05), with a median survival of 369 and 195 days, respectively (p < 0.05). None of the CVC in the VKA group required removal due to malfunction, as compared to four in the standard group. No major bleeding episodes occurred in either group.
  
  
  CONCLUSIONS
  Therapy with VKA would appear to be safe in children on chronic HD and may improve CVC survival in patients at increased risk of CVC thrombosis.
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabiopaglialonga@alice.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Artoni
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Simon
authors.initials: S
authors.lastname: Braham
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Consolo
authors.affiliation: Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Giannini
authors.affiliation: Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Chidini
authors.affiliation: Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Napolitano
authors.affiliation: A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Ida
authors.initials: I
authors.lastname: Martinelli
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D061807:Catheter Obstruction / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D008297:Male; D010865:Pilot Projects; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: Oral anticoagulants; Paediatric haemodialysis; Tunnelled central venous catheter; Vitamin K antagonists; Warfarin