A survey of the clinical management of pediatric patients with
asymptomatic central venous catheter-associated venous thromboembolism
in Saudi Arabia
Abstract
Background: Central venous catheters (CVCs) are the main cause of venous
thromboembolism (VTE) in critically ill children. The optimal first-line
treatment for children with asymptomatic CVC-related VTE is unknown. Due
to a paucity of clinical trials, clinical practice guidelines can offer
only weak recommendations for the management of asymptomatic CVC-
related VTE. Method: This case-based survey was designed to assess
current trends in local management strategies for pediatric patients
with an asymptomatic CVC- related thrombosis. The survey focused on the
use of the thrombophilia testing, management approach, duration of
anticoagulation, and the use of secondary prophylaxis. We hypothesize
that there will be significant variation in these four management areas,
in large part due to the aforementioned paucity of available
data.REDCap® questions were sent to members of the Saudi Arabian
Pediatric Hematology/Oncology Society (SAPHOS) clinical forum/email
database. We used a hypothetical case scenario to assess management
strategies for asymptomatic CVC-related VTE and secondary prophylaxis.
Results: Seventy-one (30%) physicians responded to the survey. The
majority of the respondents (83.3%) did not use thrombophilia testing.
The far majority (95%) treated with anticoagulation. In contrast, the
survey respondents varied widely in the duration of anticoagulation and
the use of secondary prophylaxis. Conclusions: Asymptomatic CVC-related
VTE is a common clinical entity with limited data guiding management. In
Saudi Arabia, there remains considerable variability in clinical
management. These findings will help identify crucial knowledge gaps in
the management of asymptomatic CVC-related VTE and facilitate clinical
trials that will help establish evidence-based treatment guidelines