Incidence and Risk Factors for Venous Thromboembolism in Critically Ill Children With Cardiac Disease |
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Authors: | Sheila J Hanson Rowena C Punzalan Melissa A Christensen Nancy S Ghanayem Evelyn M Kuhn Peter L Havens |
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Institution: | (1) Department of Pediatrics, Critical Care Medicine, Medical College of Wisconsin and Children’s Hospital and Health System, Milwaukee, WI, USA;(2) Department of Pediatrics, Hematology, Medical College of Wisconsin and Children’s Hospital and Health System, Milwaukee, WI, USA;(3) Blood Center of Wisconsin, Milwaukee, WI, USA;(4) Outcomes Department, Children’s Hospital and Health System, Milwaukee, WI, USA;(5) Department of Pediatrics, Infectious Disease, Medical College of Wisconsin and Children’s Hospital and Health System, Milwaukee, WI, USA;(6) Critical Care Department 681, Children’s Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, WI 5322, USA |
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Abstract: | Cardiac disease is a risk factor for venous thromboembolism (VTE) in children. In this study, we investigated the incidence
and risk factors of VTE in critically ill children with cardiac disease, who were prospectively followed-up for VTE after
admission to a tertiary care pediatric intensive care unit (PICU). Risk factors were compared between VTE cases and (1) patients
in the cohort who did not develop VTE and (2) the next three cardiac patients sequentially admitted to the PICU (case control).
Forty-one cases of VTE were identified from 1070 admissions (3.8%). Thirty-seven percent of VTE cases were central venous
catheter (CVC)–associated, and 56% of cases were intracardiac. Sixty-six percent of patients were receiving anticoagulation
at the time of VTE diagnosis. Increased VTE incidence was associated with unscheduled PICU admission, age <6 months, extracorporeal
membrane oxygenation, increased number of CVCs, increased number of CVC days, higher risk of mortality score, and longer PICU
stay. Using logistic regression, VTE was associated with single-ventricle physiology (odds ratio OR] 11.2, 95% CI 3.0–41.9),
widened arterial-to-somatic oxygen saturation gradient (SpO2–rSO2 >30) (OR 4.3, 95% CI 1.1–16), and more CVC days (OR 1.1, 95% CI 1.04–1.13). Risk factors for VTE in critically ill children
with cardiac disease include younger age, single-ventricle cardiac lesions, increased illness severity, unscheduled PICU admission,
and complicated hospital course. |
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