Abstract
Introduction: Children with congenital heart disease (CHD) are the largest identifiable pediatric group with thrombosis. The purpose of this study was to identify risk factors associated with venous thrombosis (VTE) in pediatric patients with heart disease. Methods: As part of a quality improvement evaluation, patients with heart disease who developed symptomatic VTE over a 10-month period were retrospectively evaluated to determine potential risk factors. Ultrasounds, Xrays, coagulation lab tests and fluid balance were evaluated. Results: 15 patients with heart disease were identified to have VTE. 9/15 (60%) had single ventricle anatomy at time of thrombus formation: 3 with Stage I Norwood or Damus-Kaye Stansel, 3 with Glenn shunts, 2 with Blalock-Taussig (BT) shunts and 1 with a pulmonary artery band. The remaining patients had CHD with 2-ventricle anatomy (n=5) and 1 had normal cardiac anatomy with severe pulmonary hypertension and biventricular heart failure. 53% were male. Patients ranged in age from 4 days to 18 months (mean age 5.3 months). 93% patients had at least 1 VTE associated with a central venous line (CVL) detected by ultrasound, with 1 patient developing thrombus in a BT shunt. 46.7% had >1 location with VTE. 78.6% had percutaneous CVLs, with line tip not within vena cava in 63.6%. Mean number of days from central line insertion to thrombus discovery was 8.6 days. 33% of patients were on heparin at time of thrombus discovery to maintain shunt patency, but none had systemic levels of heparin. General inflammatory state, line association, and surgery 200 ml/day) developed VTE. Only 2 patients were found to have a genetic prothrombotic predisposition. Conclusions: Patients with heart disease are at high risk for VTE development due to multiple risk factors; this can be particularly worrisome in single ventricle patients who rely on patent neck and chest venous connections for appropriate function of palliated cardiac shunts. These risk factors can help further develop anticoagulation protocols and VTE management for this complex population.
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