ISTH Congress Abstracts

Official abstracts site for the ISTH Congress

MENU 
  • Home
  • Congress Archive
    • ISTH 2021 Congress
    • ISTH 2020 Congress
  • Resources
  • Search

NEOCLOT: Management of Catheter-related Venous Thrombosis in Preterm and Term Neonates

C.H. Van Ommen1, K.A Bergman2, M. Boerma1, A.E. Donker3, M. Gouvernante1, C.V. Hulzebos2, D. Khandour1, R Knol1, K. Liem4, R.A. van Lingen5, M. van de Loo6, E Lopriore7, M. van der Putten8, M. Raets8, J.J. Sol9, M.H. Suijker10, D.C. Vijlbrief10, R Visser7, M.M van Weissenbruch6, NEOCLOT Study Group

1Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands, 2Beatrix Children’s Hospital UMCG, Groningen, Netherlands, 3Maxima Medisch Centrum, Veldhoven, Netherlands, 4Amalia Children’s Hospital Radboud UMC, Nijmegen, Netherlands, 5Isala Clinics, Zwolle, Netherlands, 6Amsterdam UMC, Amsterdam, Netherlands, 7Willem-Alexander Hospital LUMC, Leiden, Netherlands, 8MUMC, Maastricht, Netherlands, 9Reinier de Graafgasthuis, Delft, Netherlands, 10Wilhelmina Children’s Hospital UMCU, Utrecht, Netherlands

Abstract Number: OC 20.1

Meeting: ISTH 2021 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: In critically ill (preterm) neonates, catheter-related venous thrombosis (CVT) can be a life-threatening complication. CVT management varies among neonatal intensive care units (NICUs). In the Netherlands, a consensus-based national management guideline has been developed to create uniform CVT management, which was implemented in all 10 Dutch NICUs in 2014.

Aims: To evaluate the efficacy and safety of the Dutch neonatal CVT management guideline.  

Methods: This multicentre prospective observational cohort study included (preterm) neonates (0-6 months) with CVT, admitted to one of the 10 Dutch NICUs between 2014 and 2019. CVT management was divided into treatment of CVT in veins or right atrium (RA); algorithms are shown in figure 1. Primary outcomes were death due to CVT, recurrent thrombosis, major bleeding. Secondary outcomes were clinically relevant bleeding and thrombotic burden at the end of treatment.
Management neonatal venous catheter-related thrombosis according to NEOCLOT guideline. Abbreviations: RA right atrium, WS wait and see, US ultrasonography, r-tPA recombinant tissue plasminogen activator

Results: Totally, 116 neonates were included (male: n=71;preterm: n=92) with median gestational age 28 4/7 weeks (range:24-41 4/7), and median birthweight 1092 gram (range: 425-5384). Symptoms occurred in 87 (75%) neonates, including thrombocytopenia (43%), persisting infection (26%) or swollen leg/arm (24%). Risk factors were (suspected) infection (60%), surgery (12%), shock (11%). Applied management is shown in table 2. One (0.9%) neonate died due to pulmonary embolism, 3 (2.6%) neonates had recurrent thrombosis. Major bleeding occurred in 9 (7.8%) neonates: 2 on thrombolysis (intracranial and lung bleeding), 7 on low-molecular-weight heparin (LMWH), of which 5/7 had subcutaneous catheter-related major bleeding in the leg. One neonate had 1 clinically relevant gastro-intestinal bleeding. At the end of treatment, repeat ultrasonography (after median 49 days) was normalized, improved, unchanged or unknown in 54 (47%), 42 (36%), 9 (8%) and 11 (9%) neonates, respectively.  

Type thrombosis Management
Vein
n=72
Occlusion
n=39
n=11: Wait and see
n=27: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Non-occlusion
n=33
n=28: Wait and see
n=4: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
Right atrium
n=44
High risk
n=9
n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=2: r-TPA – anticoagulation
<half right atrium
n=35
n=23: Wait and see
n=4: Wait and see – anticoagulation.
n=6: Anticoagulation
n=1: Anticoagulation – r-TPA – anticoagulation
n=1: Wait and see – anticoagulation – r-TPA – anticoagulation
>= half right atrium
n=0

Management of 116 neonates with catheter-related venous thrombosis. Abbreviations: r-tPA, recombinant tissue plasminogen activator

Conclusions: Management of neonatal CVT according to the NEOCLOT protocol seems to be effective and safe, when not using subcutaneous catheters for LMWH administration.

To cite this abstract in AMA style:

Van Ommen CH, A Bergman K, Boerma M, Donker AE, Gouvernante M, Hulzebos CV, Khandour D, R Knol , Liem K, van Lingen RA, van de Loo M, E Lopriore , van der Putten M, Raets M, Sol JJ, Suijker MH, Vijlbrief DC, R Visser , M van Weissenbruch M, NEOCLOT Study Group . NEOCLOT: Management of Catheter-related Venous Thrombosis in Preterm and Term Neonates [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/neoclot-management-of-catheter-related-venous-thrombosis-in-preterm-and-term-neonates/. Accessed May 16, 2022.

« Back to ISTH 2021 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/neoclot-management-of-catheter-related-venous-thrombosis-in-preterm-and-term-neonates/

Simple Search

Supported By:

Bristol Myers Squibb and Pfizer

ISTH 2021 Congress site

Visit the official web site for the ISTH 2021 Virtual Congress »

  • Help & Support
  • About Us
  • Cookies & Privacy
  • Wiley Job Network
  • Terms & Conditions
  • Advertisers & Agents
Copyright © 2022 John Wiley & Sons, Inc. All Rights Reserved.
Wiley