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Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study

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Abstract

Background

To date, no study has investigated the use of vitamin K antagonists (VKA) in children undergoing chronic haemodialysis (HD) with a central venous catheter (CVC).

Methods

Consecutive patients aged <18 years with a newly placed tunnelled CVC for chronic HD were enrolled over a 3-year period. Children with active nephrotic syndrome or a history of venous thrombosis received warfarin (VKA group) with therapeutic target international normalised ratios of between 2.0 and 3.0. Patients at standard risk of CVC malfunction were not treated with VKA (standard group). The primary end-point was overall CVC survival.

Results

The VKA group consisted of nine patients (median age 10.6 years; range 1.2–15.3 years) with 11 CVC, and the standard group comprised eight patients (11.8 years; 6.1–17.3 years) with ten CVC. The 6- and 12-month CVC survival was significantly longer in the VKA group than in the standard group (100 vs. 60 % and 83.3 vs. 16.7 %, respectively; p < 0.05), with a median survival of 369 and 195 days, respectively (p < 0.05). None of the CVC in the VKA group required removal due to malfunction, as compared to four in the standard group. No major bleeding episodes occurred in either group.

Conclusions

Therapy with VKA would appear to be safe in children on chronic HD and may improve CVC survival in patients at increased risk of CVC thrombosis.

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Authors and Affiliations

  1. Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy

    Fabio Paglialonga, Silvia Consolo, Giovanni Montini & Alberto Edefonti

  2. A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy

    Andrea Artoni, Simon Braham & Ida Martinelli

  3. Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy

    Alberto Giannini, Giovanna Chidini & Luisa Napolitano

Authors
  1. Fabio Paglialonga
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  2. Andrea Artoni
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  3. Simon Braham
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  4. Silvia Consolo
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  5. Alberto Giannini
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  6. Giovanna Chidini
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  7. Luisa Napolitano
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  8. Ida Martinelli
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  9. Giovanni Montini
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  10. Alberto Edefonti
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Corresponding author

Correspondence to Fabio Paglialonga.

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Ethics statement

The study was approved by the local Ethical Committee and conforms with the Declaration of Helsinki. All parents gave written informed consent

Conflict of interest

The authors declare no conflict of interest.

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Paglialonga, F., Artoni, A., Braham, S. et al. Vitamin K antagonists in children with central venous catheter on chronic haemodialysis: a pilot study. Pediatr Nephrol 31, 827–832 (2016). https://doi.org/10.1007/s00467-015-3293-1

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  • DOI: https://doi.org/10.1007/s00467-015-3293-1

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