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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1727-1731
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Catheter-related deep venous thrombosis in children with
hemophilia
Janna M. Journeycake,
Charles T. Quinn,
Kim L. Miller,
Joy L. Zajac, and
George R. Buchanan
From the Division of Hematology-Oncology, Department of
Pediatrics, The University of Texas Southwestern Medical Center at
Dallas, Dallas, Texas, and the Center for Cancer and Blood Disorders at
Children's Medical Center of Dallas, Dallas, Texas.
Central venous catheters (CVCs) are a common adjunct to hemophilia
therapy, but the risk of CVC-related deep venous thrombosis (DVT) in
hemophiliacs is not well defined. In a previous study, 13 patients with
CVCs had no radiographic evidence of DVT. However, recent abstracts and
case studies demonstrate that DVT does occur. Therefore, this study
sought to determine the frequency of DVT in children with hemophilia
and long-term CVCs and to correlate venographic findings with clinical
features. All hemophilia patients with tunneled subclavian CVCs in
place for 12 months or more were candidates for evaluation. Patients
were examined for physical signs of DVT and questioned about catheter
dysfunction. Contrast venograms were obtained to identify DVT. Fifteen
boys with severe hemophilia were evaluated, including 9 from the
initially studied group of 13. Eight patients had evidence of DVT, 5 of
whom previously had normal venograms. Five of 15 patients had clinical
problems related to the CVC, all of whom had DVT. Four of 15 patients
had suggestive physical signs; 3 had DVT. The mean duration of catheter placement for all patients was 57.5 months (range, 12-102 months). For
patients with DVT, the mean duration was 66.6 ± 7.5 months, compared
to 49.5 ± 7.2 months for patients without DVT
(P = .06). No patient whose CVC was in place fewer than
48 months had an abnormal venogram. Many hemophilia patients with CVCs
develop DVT of the upper venous system, and the risk increases with
duration of catheter placement.
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Catheter-related thrombosis in children with hemophilia A: evidence of a multifactorial disease
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C. E. Ettingshausen, K. Kurnik, R. Schobess, W. D. Kreuz, S. Halimeh, H. Pollman, U. Nowak-Gottl ;, J. M. Journeycake, and G. R. Buchanan
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