TY - JOUR
T1 - Antithrombin activity and central venous catheter-associated thrombosis in critically ill children at high risk of bleeding
AU - ATLAS Investigators
AU - Quinn, Tyler
AU - Cholette, Jill M.
AU - Pinto, Matthew G.
AU - Schreiber, Hilary
AU - Madden, Maureen A.
AU - Bennett, Erin
AU - Kolmar, Amanda
AU - Poole, Alan
AU - Silva, Cicero T.
AU - Ehrlich, Lauren
AU - Navarro, Oscar M.
AU - Faustino, E. Vincent S.
AU - Faustino, E. Vincent S.
AU - Bennet, Erin
AU - Madding, Ashlyn
AU - Spriggs, Masson
AU - Dixon, Lexie
AU - Li, Simon
AU - Privatt, Miranda
AU - Shad, Sadaf
AU - McMichael, Ali B.V.
AU - Hugley, Mickeah
AU - Pinto, Matthew
AU - Cuddy, William
AU - Stone, Pamela
AU - Archie, Jessie
AU - Taillie, Eileen
N1 - Publisher Copyright:
© 2023 International Society on Thrombosis and Haemostasis
PY - 2024/1
Y1 - 2024/1
N2 - 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.
AB - 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.
KW - antithrombin deficiency
KW - deep venous thrombosis
KW - intensive care units
KW - pediatric
KW - thrombin
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85174466916&partnerID=8YFLogxK
U2 - 10.1016/j.jtha.2023.09.023
DO - 10.1016/j.jtha.2023.09.023
M3 - Article
C2 - 37797693
AN - SCOPUS:85174466916
SN - 1538-7933
VL - 22
SP - 213
EP - 224
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 1
ER -