Age-Dependent Heterogeneity in the Efficacy of Prophylaxis With Enoxaparin Against Catheter-Associated Thrombosis in Critically Ill Children: A Post Hoc Analysis of a Bayesian Phase 2b Randomized Clinical Trial
| Autor: | Matthew Pinto, Jill M. Cholette, Sheila J. Hanson, Independent Safety Monitor, Joana A. Tala, Marianne E. Nellis, Crete Trial Investigators, Tara McPartland, Cicero T. Silva, Philip C. Spinella, Leslie Raffini, Sarah B Kandil, E. Vincent S. Faustino, Veronika Shabanova, Safety Monitoring Board, Simon Li |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Catheterization Central Venous Critical Illness medicine.medical_treatment Critical Care and Intensive Care Medicine Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Interquartile range Outcome Assessment Health Care Humans Medicine Enoxaparin Thrombus Child Vein Venous Thrombosis business.industry Anticoagulants Infant Thrombosis 030208 emergency & critical care medicine medicine.disease Venous thrombosis Catheter medicine.anatomical_structure 030228 respiratory system Child Preschool Anesthesia Female Pre-Exposure Prophylaxis business Central venous catheter |
| Zdroj: | Crit Care Med |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000004848 |
| Popis: | Objectives We explored the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against central venous catheter-associated deep venous thrombosis in critically ill children. Design Post hoc analysis of a Bayesian phase 2b randomized clinical trial. Setting Seven PICUs. Patients Children less than 18 years old with newly inserted central venous catheter. Interventions Enoxaparin started less than 24 hours after insertion of central venous catheter and adjusted to anti-Xa level of 0.2-0.5 international units/mL versus usual care. Measurements and main results Of 51 children randomized, 24 were infants less than 1 year old. Risk ratios of central venous catheter-associated deep venous thrombosis with prophylaxis with enoxaparin were 0.98 (95% credible interval, 0.37-2.44) in infants and 0.24 (95% credible interval, 0.04-0.82) in older children greater than or equal to 1 year old. Infants and older children achieved anti-Xa level greater than or equal to 0.2 international units/mL at comparable times. While central venous catheter was in situ, endogenous thrombin potential, a measure of thrombin generation, was 223.21 nM.min (95% CI, 8.78-437.64 nM.min) lower in infants. Factor VIII activity, a driver of thrombin generation, was also lower in infants by 45.1% (95% CI, 15.7-74.4%). Median minimum platelet count while central venous catheter was in situ was higher in infants by 39 × 103/mm3 (interquartile range, 17-61 × 103/mm3). Central venous catheter:vein ratio was not statistically different. Prophylaxis with enoxaparin was less efficacious against central venous catheter-associated deep venous thrombosis at lower factor VIII activity and at higher platelet count. Conclusions The relatively lesser contribution of thrombin generation on central venous catheter-associated thrombus formation in critically ill infants potentially explains the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin. |
| Databáze: | OpenAIRE |
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