Short term outcome of neonatal venous thromboembolism in anticoagulated versus observed patients

Abstract

Background

Advancements in the medical field and increased survival of premature infants have led to a rise of venous thromboembolism (VTE) in neonates. Neonatal hemostasis exists in a delicate balance with a propensity towards pro-coagulation. Current recommendations include careful observation, therapeutic anti-coagulation and in some cases thrombolysis. We hypothesize that a sub-group of neonates may not require anti-coagulation and could be safely observed thus reducing their risk of bleeding complications.

Methods

We conducted a retrospective chart review of patients with VTE admitted to the neonatal intensive care unit at the Oklahoma University Children's Hospital from October 2009–October 2019. Patients were selected if they had an ICD-9 or ICD-10 code specific for a VTE or if screening with CPT codes for diagnostic imaging including echocardiogram, venous dopplers and computed topographic/magnetic resonance venogram revealed the word ‘thrombus’, ‘clot’ or ‘venous thromboembolism’. Data were collected about demographics, medical history, co-morbidities, thrombosis characteristics, treatment and outcome.

Results

A total of 211 patients were screened and 119 patients were eligible and included in the study. The majority of patients (85 %) had a central venous catheter (CVC) associated VTE. Two-thirds of patients (n = 81, 68 %) received therapeutic anti-coagulation while one-third (n = 38, 32 %) were observed. The group that received anticoagulation had a significantly older age at diagnosis and had a higher frequency of bacteremia, congenital heart disease and presence of symptoms. There was no difference in the odds of complete resolution between patients who were treated with therapeutic anti-coagulation and those that were observed (OR: 1.37, 95 % CI: 0.59–3.20, p-value: 0.47). Univariate analysis revealed maternal preeclampsia (OR: 0.2, 95 % CI: 0.05–0.82, p-value = 0.025), maternal history of chronic hypertension (OR: 0.17, 95 % CI: 0.04–0.68, p-value = 0.01), and presence of complete occlusion (OR = 0.37, 95 % CI: 0.15–0.91, p-value = 0.03) significantly reduced the odds of complete resolution. Furthermore, having a VTE related to a CVC in an extremity versus an ECMO cannula or cardiac catheterization significantly improved the odds of VTE resolution (OR = 5.94, 95 % CI: 1.30–27.20, p-value = 0.022). Using a stepwise regression model, maternal history of chronic hypertension remained significant for a reduced odds of VTE resolution (OR: 0.14, 95 % CI 0.025–0.73, p-value: 0.02).

Conclusions

The short-term outcome of neonatal VTE does not seem to differ between those that were anticoagulated and those that were observed with serial imaging.