title: Prevalence of Symptomatic and Asymptomatic Thrombosis in Pediatric Oncology Patients With Tunneled Central Venous Catheters.
abstract: Pediatric oncology patients with tunneled central venous catheters (CVCs) are at increased risk to develop venous thromboembolic events (VTEs), but the true prevalence of (a)symptomatic VTE is unknown. Aim of this study was to evaluate the prevalence of (a)symptomatic VTE in pediatric oncology patients with tunneled CVCs.
  
  
  
  All patients were included in the Aristocaths study: a randomized controlled multicenter trial investigating the prophylactic effect of 70% ethanol locks on CVC-associated bloodstream infections (CABSIs) were eligible for this study. We assessed the following outcomes: (i) symptomatic VTE and (ii) asymptomatic CVC-related VTE (using ultrasound [US]). Follow-up was 6 months, unless patients developed one of the following events: VTE, CABSI, CVC removal, or death.
  
  
  
  We included 305 patients (hematologic malignancy, n = 148; solid tumor, n = 157), median age 9 years (range, 1-18 years). Symptomatic VTE was detected in 8 of 305 patients (2.6%; 95% confidence interval [CI]: 1.1-5.1%), which was related to the CVC in three patients. Patients (185/305) were evaluated with US: 11 of 185 (5.9%; 95% CI: 3.0-10.4%) patients had asymptomatic CVC-related VTE.
  
  
  
  Prevalence of both symptomatic VTE and asymptomatic CVC-related VTE was low compared to other studies, which may be explained by the inclusion of patients with solid tumors, reduction of CABSI by ethanol, use of tunneled CVCs, and use of US.
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Reineke A
authors.initials: RA
authors.lastname: Schoot
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.affiliation: Department of Pediatric Oncology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Erna
authors.initials: E
authors.lastname: Michiels
authors.affiliation: Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Floor C H
authors.initials: FC
authors.lastname: Abbink
authors.affiliation: Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Martine F
authors.initials: MF
authors.lastname: Raphael
authors.affiliation: Pediatric Surgical Center Amsterdam, Academic Medical Center & VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Zwaan
authors.affiliation: Dutch Childhood Oncology Group, The Hague, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Lieverst
authors.affiliation: Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Hubert N
authors.initials: HN
authors.lastname: Caron
authors.affiliation: Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: van Ommen
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D015995:Prevalence; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D000431:Ethanol; D006493:Heparin
keywords: cancer; central venous catheters; ethanol; pediatrics; venous thrombosis