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).