Antithrombin activity and central venous catheter-associated thrombosis in critically ill children at high risk of bleeding

ATLAS Investigators, Tyler Quinn, Jill M. Cholette, Matthew G. Pinto, Hilary Schreiber, Maureen A. Madden, Erin Bennett, Amanda Kolmar, Alan Poole, Cicero T. Silva, Lauren Ehrlich, Oscar M. Navarro, E. Vincent S. Faustino, E. Vincent S. Faustino, Erin Bennet, Ashlyn Madding, Masson Spriggs, Lexie Dixon, Simon Li, Miranda PrivattSadaf Shad, Ali B.V. McMichael, Mickeah Hugley, Matthew Pinto, William Cuddy, Pamela Stone, Jessie Archie, Eileen Taillie

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Normalization of antithrombin activity may prevent catheter-associated thrombosis in critically ill children at high risk of bleeding. Objectives: To characterize the temporal pattern of antithrombin activity, assess its association with catheter-associated thrombosis and clinically relevant bleeding, and evaluate its relationship with thrombin generation in these children. Methods: In this prospective cohort study, critically ill children <18 years old at high risk of bleeding with central venous catheter were eligible. Antithrombin activity and thrombin generation were measured from platelet-poor plasma and after in vitro antithrombin supplementation. Systematic surveillance ultrasound was performed to diagnose thrombosis. Children were followed for bleeding. Results: We enrolled 8 infants (median age: 0.2 years, IQR: 0.2, 0.3 years) and 72 older children (median age: 14.3 years, IQR: 9.1, 16.1 years). Mean antithrombin on the day of catheter insertion was 64 IU/dL (SD: 32 IU/dL) in infants and 83 IU/dL (SD: 35 IU/dL) in older children. Antithrombin normalized by the day of catheter removal. Thrombosis developed in 27 children, while 31 children bled. Thrombosis (regression coefficient: 0.008, 95% CI: -0.01, 0.03) and bleeding (regression coefficient: -0.0007, 95% CI: -0.02, 0.02) were not associated with antithrombin. Antithrombin was not correlated with in vivo change in endogenous thrombin potential (correlation coefficient: -0.07, 95% CI: -0.21, 0.08). In vitro supplementation reduced endogenous thrombin potential (correlation coefficient: -0.78; 95% CI: -0.95, -0.23). Conclusion: These findings may not support normalization of antithrombin activity to prevent catheter-associated thrombosis in critically ill children at high risk of bleeding.

Original languageEnglish
Pages (from-to)213-224
Number of pages12
JournalJournal of Thrombosis and Haemostasis
Volume22
Issue number1
DOIs
StatePublished - Jan 2024

Keywords

  • antithrombin deficiency
  • deep venous thrombosis
  • intensive care units
  • pediatric
  • thrombin
  • venous thromboembolism

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