ANTICOAGULATION WITHOUT CATHETER REMOVAL IN CHILDREN WITH CATHETER-RELATED CENTRAL VEIN-THROMBOSIS

Catheter-related central venous thrombosis is a serious and common pro blem among children. The traditional management has been anticoagulati on and early catheter removal. Unfortunately, many patients require a new catheter, which is associated with complications that include poss ible further thrombosis. Although others have used thrombolytic agents in attempts to avoid catheter removal, the authors of the present stu dy believe that the associated complications occur too frequently and are too serious. They have had success with standard anticoagulation i n a limited number of patients. Between February 1991 and April 1994, 17 patients (6 weeks to 19 years of age) were treated for catheter-rel ated deep venous thrombosis. Eight patients underwent early catheter r emoval accompanied by anticoagulation; two of them had intrinsic cathe ter problems that necessitated removal, and one had hemophilia. Nine o thers received anticoagulation without catheter removal. Of these, one required catheter removal after 10 days heparin administration failed to diminish the thrombosis. Another patient responded well to anticoa gulation but required catheter removal several weeks later because of catheter-site infection. The other seven patients responded well to an ticoagulation, and their catheters were retained. For patients with a functional catheter essential to their care, anticoagulation may safel y prevent catheter removal. Copyright (C) 1996 by W.B. Saunders Compan y