Results:
A total of 149 patients aged two months to five years were identified as
having DKA between January 2002 and December 2011. Seventeen (11.4%) of
these patients underwent CVC placement for management of their DKA, of
which nine (52.9%) were subsequently diagnosed radiographically by
Doppler ultrasonography with a CVC-associated VTE (Table 1). These nine
events all occurred between days 3-5 of the admission for DKA. There
were no VTE diagnoses in patients without CVC placement. Each CVC was
placed on hospital day one either in the emergency room or intensive
care unit and each patient received continuous fluid infusions for their
DKA management for the duration of the CVC placement. None of the 17
identified patients had a documented family or personal history of
thrombosis. The median age of the 17 patients with DKA undergoing CVC
placement was 17 months, which was significantly younger than the
33-month median age of those for whom CVC placement was not necessary
(p=<0.001). No CVC-associated VTE occurred after April 2007.
When comparing possible risk factors between patients with and without
VTE (Table 2), the only statistically significant difference noted was
that those with a VTE diagnosis had a longer median length of hospital
stay (7 days) than those who did not (4 days) (p=<0.003). The
other demographic and laboratory measures did not significantly differ
between these two groups.
All nine patients with CVC-associated VTE had anticoagulation management
with enoxaparin or standard heparin with transition to enoxaparin. None
of these patients had hemorrhagic complications and all were discharged
on therapeutic enoxaparin doses.
Thrombophilia screening was performed on the nine patients diagnosed
with a VTE at the discretion of the consulting hematologist. Protein C
activity was normal in all patients except one, whose value was 12% at
VTE diagnosis. One month into VTE treatment, protein C activity
normalized at 91%. Measured protein S activities were abnormal in two
patients, aged 39 months and 12 months, whose values were 52% and 49%
at VTE diagnosis with age specific lower limit of normal being 67% for
both cases. These values were not reassessed post-treatment.
Anticardiolipin IgG antibody testing was within the intermediate range
at 16.8 GPL units in one patient (upper limit of normal is 15 GPL
units). This value was not reassessed.
Over the 10-year study period, 3,038 CVCs were placed hospital wide for
any reason other than DKA in patients aged two month to five years.
Fifty two (1.7%) developed a VTE within three months of line placement,
33 of which were diagnosed within one month. The prevalence of
CVC-associated VTE in the 17 patients with DKA undergoing CVC placement
(52.9%) was significantly higher than that for CVC placement for any
other reason (p<0.001).