1. THE VALUE OF THROMBOPROPHYLAXIS IN PEDIATRIC CANCER PATIENTS WITH CENTRAL
VENOUS CATHETERS (CVC): A CLOSER LOOK AT THE LITERATURE
Aguirre F, Sekiguchi L, Yeung K, Alcayde M, Epstein J, Chintalapati N, Le A, Mehta A, Afghani
B.
Purpose of Study: Pediatric cancer patients undergoing chemotherapy are at increased risk of venous
thromboembolism (VTE). The objective of this study is to determine whether primary thromboprophylax-
is lowers the risk of VTE in pediatric cancer patients with central venous catheters.
Methods Used: A literature based review through PubMed and Cochrane databases using key terms such
as: VTE, cancer, pediatrics, CVC, prophylaxis, anti-coagulant. Studies which included cancer patients <
18 years of age with central-venous catheters and no history of VTE as well as a control group were in-
cluded in our review.
Summary of Results: From the 38 articles we found, 4 that met our inclusion criteria. Majority of the
studies excluded focused on adults or did not include a control group. Table below summarized the effec-
tiveness of thromboprophylaxis and major side effects. The risk of VTE was lower in 2 studies that used
low molecular weight (LMWH) as part of prophylaxis but one study that used LMWH did not show any
difference between the prophylaxis and control group.
Conclusions: There may be a role of anti-coagulants for prophylaxis of VTE in pediatric cancer patients
with CVCs. Further studies are needed to evaluate other confounding variables, safety as well as cost-ef-
fectiveness of thromboprophylaxis in such patients.
1st au-
thor,
year Control
Pro-
phy-
laxis
Group
% of VTE
in Anti-
coag
% VTE
in
con-
trol
P
val-
ue
Any oth-
er seri-
ous side-
effects
of anti-
coagu-
lant
drugs
Was pa-
tient dis-
contin-
ued due
to side
effects
D
ur
at
io
n
on
pr
op
hy
la
xi
s
Fol-
low-up
period
Ruud,
2007
No pro-
phylaxis
(n=33)
war-
farin
(n=29)
14/29
(48%)
12/33
(36%)
p=0.
44
Most
thrombi
were
transient
yes
(n=11)
>6
m
os
1,3,6
mos
Elhasid,
2001
Matched
histori-
cal con-
trols
(n=50)
LMWH
(n=27)
1/41
(2.4%)
2/50
(10%)
p<0.
05
1 patient
LMWH
had brain
infarct no
6
m
os
1,3,6
mos

2.
Massi-
cottea,
2003
No pro-
phylaxis
(n=80)
LMWH
(n=92)
11/78
(14.1%)
10/80
(12.5%
)
p=0.
41
Bleeding,
2 deaths
in control
no; 15%
(n=28)
were not
evaluable
30
da
ys
2
weeks
Meister,
2008
Histori-
cal con-
trols
who got
An-
tithrom
bin only
(n=71)
LMWH
and
An-
tithro
mbin
(n=41) 0/41 (0%)
9/71
(12.7%
)
p=0.
02 no no
45
da
ys 34w 2d