A retrospective study of the factors associated with hypercoagulability in the pediatric patients at a tertiary care children's hospital

作者：Slamon Nicholas^*; Krueger Leslie J; Edelson Maureen; Glutting Joseph J; Rittenhouse David

来源：Pediatric Critical Care Medicine, 2008, 9(5): 511-516.

DOI：10.1097/PCC.0b013e3181849dfe

• central venous catheter
• hypercoagulability
• pediatrics
• thrombosis

Objective: The objective of this study was to determine the risk factors of hypercoagulability in children. We explored the interaction of multiple risk factors with the incidence of thrombosis. Our hypothesis was that as the number of risk factors for thrombosis increased the actual incidence of thrombosis would also increase.
Design: Retrospective review from 2003 through 2006 based on a search using two electronic medical record databases.
Setting: Pediatric Tertiary Care Children's Hospital.
Patients: Two hundred twenty-six patients were identified and analyzed.
Measurements: Search terms included factor V Leiden polymerase chain reaction, prothrombin gene 20210A mutation, methylene tetrahydrofolate reductase mutation, antithrombin III, and protein C and S levels. Clinical data were compiled for regression analysis.
Main Results: The presence of one risk factor was not significant. Two risk factors increased the risk of thrombosis (p = 0.005; OR 3.128). Three or more risk factors further increased the risk of thrombosis (p = 0.003; OR 4.861). Older age (>11 yrs) was protective against thrombosis (p = 0.007; OR 0.995), and the presence of a central venous catheter when analyzed against accumulating risk factors showed a higher risk than that found during the regression analysis (p = 0.001; OR 3.638).
Conclusions: The population at our institution is reflective of the previously reported standards for the genetic predispositions toward thrombosis. Although older age is associated with a lower incidence of thrombosis, the presence of a central venous access device is detrimental. Accumulation of factors results in an increased risk of thrombosis. This article suggests that when inserting a central venous access device, consideration of a hypercoagulation workup should occur. Those with any two or more risk factors, genetic or acquired, and the comorbidity of a CVL may warrant consideration for the institution of anticoagulation with an agent like low molecular weight heparin. (Pediatr Crit Care Med 2008; 9:511-516)

• 出版日期2008-9