Herding CATs? The Incidence and Prevention of Catheter-Associated Thromboses (CATs) in Pediatric Patients after Cardiac Transplant

Abstract

The presence of central venous lines (CVLs) post cardiac transplant increases the risk of catheter-associated thromboses (CATs) impacting vascular access. CATs also contribute to the need for prolonged anticoagulation increasing the risk of bleeding and diminished quality of life. Little data exists quantifying the incidence of CATs or associated risk factors after cardiac transplantation in pediatric patients. We aimed to study the incidence of CATs and the impact of a risk-stratified anticoagulation protocol in reducing their development. This is a single-center, retrospective review of patients less than 18 years of age with CVLs after cardiac transplantation from 2009-2018. Data collected included demographic data, CVL location, thrombosis data, anticoagulant use, and adverse events. Patients were started on an anticoagulation (AC) protocol (see Table 1) after 2016 and were compared to pre-protocol patients. CATs were noted in 39 (42%) of 93 patients analyzed. Eight (8.6%) patients experienced major bleeding which was associated with older age (p=0.021) and history of congenital heart defect (p=0.067). There were 76 patients prior to AC protocol implementation compared to 17 post-protocol. Preliminary analyses showed no difference in the rate of CATs (42.1% vs. 41.2%, p=0.54); however, of clots that developed after implementation, there were significantly fewer occlusive thromboses (15.8% vs. 35.3%, p=0.05) decreasing the need for further anticoagulation by 13.3%. This study highlights the significant risk of CATs after heart transplantation in pediatric patients. In an attempt to decrease the rate of CATs, a risk-stratified AC protocol was developed and implemented. Though initial data is limited, patients who received early post-operative anticoagulation after transplant had less severe CATs and decreased need for therapy after line removal.