Device-Related Thrombosis and Bleeding in Pediatric Care: Insights from a Meta-Analysis
Introduction:
Invasive devices are essential in pediatric healthcare, but they carry risks of thrombosis and bleeding. This meta-analysis provides a comprehensive estimate of these complications, helping clinicians make informed decisions and improve patient outcomes.
Background:
Thrombosis and bleeding associated with invasive devices contribute significantly to morbidity and mortality in pediatric patients. Despite the widespread use of these devices, the prevalence and rates of such complications by device type are not well-documented.
Objective:
This study aims to estimate pooled proportions and rates of thrombotic and bleeding complications related to various invasive devices in pediatric healthcare.
Methods:
Data Sources: The meta-analysis included studies from Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases.
Study Selection: Cohort studies and trials published between January 2011 and June 2022 that reported on thrombotic and bleeding complications in pediatric patients with invasive devices were included.
Outcomes: The primary outcomes measured were device-specific thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor).
Key Findings:
1. Central Venous Access Devices (CVADs):
- Symptomatic Venous Thromboembolism: 4% (95% CI, 3-5), with an incidence rate of 0.03 per 1000 device-days.
- Asymptomatic Thrombosis: 10% (95% CI, 7-13), with an incidence rate of 0.25 per 1000 device-days.
2. Ventricular Assist Devices: Associated with major bleeding complications in 28% of cases (95% CI, 19-39).
3. Extracorporeal Membrane Oxygenation (ECMO): Major bleeding complications occurred in 67% of cases (95% CI, 52-81).
Conclusions:
The meta-analysis provides valuable estimates of the incidence and prevalence of thrombosis and bleeding complications associated with invasive devices in pediatric care. These findings can inform clinical decision-making, guide risk assessments, and enhance surveillance strategies to minimize these risks in pediatric patients.
Authors: Amanda Ullman, Areum Hyun, Victoria Gibson, Fiona Newall, Mari Takashima
